|
OS INTERPHAS INSIT HYBRDZAT 2
|
Facility
|
OP
|
$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 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 |
30001497
|
|
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 2
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001497
|
|
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 IN SITU HYBRID 1
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001494
|
|
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 IN SITU HYBRID 1
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001494
|
|
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 IN SITU HYBRID 3
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001493
|
|
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 IN SITU HYBRID 3
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001493
|
|
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 IN SITU HYBRID 4
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001496
|
|
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 IN SITU HYBRID 4
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001496
|
|
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 IN SITU HYBRID 5
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001495
|
|
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 IN SITU HYBRID 5
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001495
|
|
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 IN SITU HYBRID 6
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001492
|
|
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 IN SITU HYBRID 6
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001492
|
|
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 SITU HYBRIDZATI
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 88274
|
| Hospital Charge Code |
30001490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem Medicaid |
$42.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.38
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Humana KY Medicaid |
$42.38
|
| Rate for Payer: Humana Medicare Advantage |
$42.38
|
| Rate for Payer: Kentucky WC Medicaid |
$42.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.52
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
OS INTERPHAS SITU HYBRIDZATI
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 88274
|
| Hospital Charge Code |
30001490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.48
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.52
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
OS INTRINSIC FACTOR BL. AB
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 86340
|
| Hospital Charge Code |
30001072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$15.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.08
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$15.08
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$15.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
OS INTRINSIC FACTOR BL. AB
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 86340
|
| Hospital Charge Code |
30001072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
OS Iodine/Creat Ratio, U
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
30001866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$198.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.17
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$214.14
|
| Rate for Payer: First Health Commercial |
$245.10
|
| Rate for Payer: Humana Commercial |
$219.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$211.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$190.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.04
|
| Rate for Payer: Ohio Health Group HMO |
$193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.98
|
| Rate for Payer: PHCS Commercial |
$247.68
|
| Rate for Payer: United Healthcare All Payer |
$227.04
|
|
|
OS Iodine/Creat Ratio, U
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
30001866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$198.66
|
| Rate for Payer: Anthem Medicaid |
$24.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.11
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$214.14
|
| Rate for Payer: First Health Commercial |
$245.10
|
| Rate for Payer: Humana Commercial |
$219.30
|
| Rate for Payer: Humana KY Medicaid |
$24.11
|
| Rate for Payer: Humana Medicare Advantage |
$24.11
|
| Rate for Payer: Kentucky WC Medicaid |
$24.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$211.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$190.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.04
|
| Rate for Payer: Ohio Health Group HMO |
$193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.98
|
| Rate for Payer: PHCS Commercial |
$247.68
|
| Rate for Payer: United Healthcare All Payer |
$227.04
|
|
|
OS ISLET CELL CYTOPLASMAB IGG
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
30001074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.71 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: Aetna Commercial |
$205.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.40
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$221.61
|
| Rate for Payer: First Health Commercial |
$253.65
|
| Rate for Payer: Humana Commercial |
$226.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.96
|
| Rate for Payer: Ohio Health Group HMO |
$200.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.77
|
| Rate for Payer: PHCS Commercial |
$256.32
|
| Rate for Payer: United Healthcare All Payer |
$234.96
|
|
|
OS ISLET CELL CYTOPLASMAB IGG
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
30001074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: Aetna Commercial |
$205.59
|
| Rate for Payer: Anthem Medicaid |
$23.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.57
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$221.61
|
| Rate for Payer: First Health Commercial |
$253.65
|
| Rate for Payer: Humana Commercial |
$226.95
|
| Rate for Payer: Humana KY Medicaid |
$23.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.57
|
| Rate for Payer: Kentucky WC Medicaid |
$23.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.96
|
| Rate for Payer: Ohio Health Group HMO |
$200.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.77
|
| Rate for Payer: PHCS Commercial |
$256.32
|
| Rate for Payer: United Healthcare All Payer |
$234.96
|
|
|
OS ISOCYANATE HDI IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000817
|
|
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 ISOCYANATE HDI IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000817
|
|
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 ISPAGHULA IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000703
|
|
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 ISPAGHULA IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000703
|
|
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
|
|
