|
OS ALLERGEN IGE CHOCOL COCOA
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000669
|
|
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 ALMOND IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000649
|
|
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 ALMOND IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000649
|
|
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 ALPHA 1 ANTITRYPSIN PHENOTY
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 82104
|
| Hospital Charge Code |
30000232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$14.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.46
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$14.46
|
| Rate for Payer: Humana Medicare Advantage |
$14.46
|
| Rate for Payer: Kentucky WC Medicaid |
$14.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OS ALPHA 1 ANTITRYPSIN PHENOTY
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 82104
|
| Hospital Charge Code |
30000232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OS ALPHA 1 ANTITRYPSIN SERUM
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 82103
|
| Hospital Charge Code |
30000231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem Medicaid |
$13.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.44
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| Rate for Payer: Humana KY Medicaid |
$13.44
|
| Rate for Payer: Humana Medicare Advantage |
$13.44
|
| Rate for Payer: Kentucky WC Medicaid |
$13.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.64
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
OS ALPHA 1 ANTITRYPSIN SERUM
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 82103
|
| Hospital Charge Code |
30000231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.57
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.64
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
OS Alpha Defensin-SF
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30001842
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| 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 |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
OS Alpha Defensin-SF
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30001842
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
OS ALPHA FETOPROTEIN
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
30000233
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$16.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.77
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Humana KY Medicaid |
$16.77
|
| Rate for Payer: Humana Medicare Advantage |
$16.77
|
| Rate for Payer: Kentucky WC Medicaid |
$16.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
OS ALPHA FETOPROTEIN
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
30000233
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
OS Alpha-Galactosidase, S
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 82657
|
| Hospital Charge Code |
30001885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem Medicaid |
$22.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.17
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Humana KY Medicaid |
$22.17
|
| Rate for Payer: Humana Medicare Advantage |
$22.17
|
| Rate for Payer: Kentucky WC Medicaid |
$22.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
OS Alpha-Galactosidase, S
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 82657
|
| Hospital Charge Code |
30001885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.25
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
OS ALPRAZOLAM/TEMAZEPAM S
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
30000112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$58.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$58.81
|
| Rate for Payer: Kentucky WC Medicaid |
$59.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.99
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
OS ALPRAZOLAM/TEMAZEPAM S
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.99
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
OS ALPRAZOLAM/TEMAZEPAM S
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.99
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
OS ALPRAZOLAM/TEMAZEPAM S
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
30000112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.99
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
OS ALT
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
30000537
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$5.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.30
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Humana KY Medicaid |
$5.30
|
| Rate for Payer: Humana Medicare Advantage |
$5.30
|
| Rate for Payer: Kentucky WC Medicaid |
$5.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
OS ALT
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
30000537
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
OS ALUMINUM SERUM
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 82108
|
| Hospital Charge Code |
30000234
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.24
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
OS ALUMINUM SERUM
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 82108
|
| Hospital Charge Code |
30000234
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem Medicaid |
$25.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.48
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Humana KY Medicaid |
$25.48
|
| Rate for Payer: Humana Medicare Advantage |
$25.48
|
| Rate for Payer: Kentucky WC Medicaid |
$25.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.24
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
OS AMAPHETAMINES MH
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS 80325
|
| Hospital Charge Code |
30000084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem Medicaid |
$7.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Humana KY Medicaid |
$7.57
|
| Rate for Payer: Kentucky WC Medicaid |
$7.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
OS AMAPHETAMINES MH
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
OS AMAPHETAMINES MH
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS 80325
|
| Hospital Charge Code |
30000084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
OS AMAPHETAMINES MH
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
