|
OS ANTI FLA X
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000399
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.09
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$24.90
|
| Rate for Payer: First Health Commercial |
$28.50
|
| Rate for Payer: Humana Commercial |
$25.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.40
|
| Rate for Payer: Ohio Health Group HMO |
$22.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.70
|
| Rate for Payer: PHCS Commercial |
$28.80
|
| Rate for Payer: United Healthcare All Payer |
$26.40
|
|
|
OS Anti-Golimumab Antibody
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30001896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: Aetna Commercial |
$157.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.81
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$169.32
|
| Rate for Payer: First Health Commercial |
$193.80
|
| Rate for Payer: Humana Commercial |
$173.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.52
|
| Rate for Payer: Ohio Health Group HMO |
$153.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.76
|
| Rate for Payer: PHCS Commercial |
$195.84
|
| Rate for Payer: United Healthcare All Payer |
$179.52
|
|
|
OS Anti-Golimumab Antibody
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30001896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: Aetna Commercial |
$157.08
|
| Rate for Payer: Anthem Medicaid |
$14.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.12
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$169.32
|
| Rate for Payer: First Health Commercial |
$193.80
|
| Rate for Payer: Humana Commercial |
$173.40
|
| Rate for Payer: Humana KY Medicaid |
$14.12
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$14.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.52
|
| Rate for Payer: Ohio Health Group HMO |
$153.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.76
|
| Rate for Payer: PHCS Commercial |
$195.84
|
| Rate for Payer: United Healthcare All Payer |
$179.52
|
|
|
OS ANTIHISTONE AB
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
30000380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.16
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.03
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
OS ANTIHISTONE AB
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
30000380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem Medicaid |
$17.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Humana KY Medicaid |
$17.93
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Kentucky WC Medicaid |
$18.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.03
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
OS ANTI I2
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000419
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna Commercial |
$25.73
|
| Rate for Payer: First Health Commercial |
$29.45
|
| Rate for Payer: Humana Commercial |
$26.35
|
| Rate for Payer: Humana KY Medicaid |
$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 |
$25.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.28
|
| Rate for Payer: Ohio Health Group HMO |
$23.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$29.76
|
| Rate for Payer: United Healthcare All Payer |
$27.28
|
|
|
OS ANTI I2
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000419
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.89
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna Commercial |
$25.73
|
| Rate for Payer: First Health Commercial |
$29.45
|
| Rate for Payer: Humana Commercial |
$26.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.28
|
| Rate for Payer: Ohio Health Group HMO |
$23.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$29.76
|
| Rate for Payer: United Healthcare All Payer |
$27.28
|
|
|
OS ANTI-MULLERIAN HORMONE
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 82166
|
| Hospital Charge Code |
30000274
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: Aetna Commercial |
$142.45
|
| Rate for Payer: Anthem Medicaid |
$38.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.62
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: First Health Commercial |
$175.75
|
| Rate for Payer: Humana Commercial |
$157.25
|
| Rate for Payer: Humana KY Medicaid |
$38.62
|
| Rate for Payer: Humana Medicare Advantage |
$38.62
|
| Rate for Payer: Kentucky WC Medicaid |
$39.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.80
|
| Rate for Payer: Ohio Health Group HMO |
$138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.65
|
| Rate for Payer: PHCS Commercial |
$177.60
|
| Rate for Payer: United Healthcare All Payer |
$162.80
|
|
|
OS ANTI-MULLERIAN HORMONE
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 82166
|
| Hospital Charge Code |
30000274
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: Aetna Commercial |
$142.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.56
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: First Health Commercial |
$175.75
|
| Rate for Payer: Humana Commercial |
$157.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.80
|
| Rate for Payer: Ohio Health Group HMO |
$138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.65
|
| Rate for Payer: PHCS Commercial |
$177.60
|
| Rate for Payer: United Healthcare All Payer |
$162.80
|
|
|
OS ANTI OMPC IGA
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$26.18
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cigna Commercial |
$28.22
|
| Rate for Payer: First Health Commercial |
$32.30
|
| Rate for Payer: Humana Commercial |
$28.90
|
| 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 |
$27.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.92
|
| Rate for Payer: Ohio Health Group HMO |
$25.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.46
|
| Rate for Payer: PHCS Commercial |
$32.64
|
| Rate for Payer: United Healthcare All Payer |
$29.92
|
|
|
OS ANTI OMPC IGA
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$26.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cigna Commercial |
$28.22
|
| Rate for Payer: First Health Commercial |
$32.30
|
| Rate for Payer: Humana Commercial |
$28.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.92
|
| Rate for Payer: Ohio Health Group HMO |
$25.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.46
|
| Rate for Payer: PHCS Commercial |
$32.64
|
| Rate for Payer: United Healthcare All Payer |
$29.92
|
|
|
OS ANTI-PHOSPHOLIPID ANTIBODY
|
Facility
|
OP
|
$296.25
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
30002012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$284.40 |
| Rate for Payer: Aetna Commercial |
$228.11
|
| Rate for Payer: Anthem Medicaid |
$16.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.07
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cigna Commercial |
$245.89
|
| Rate for Payer: First Health Commercial |
$281.44
|
| Rate for Payer: Humana Commercial |
$251.81
|
| Rate for Payer: Humana KY Medicaid |
$16.07
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Kentucky WC Medicaid |
$16.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.70
|
| Rate for Payer: Ohio Health Group HMO |
$222.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.41
|
| Rate for Payer: PHCS Commercial |
$284.40
|
| Rate for Payer: United Healthcare All Payer |
$260.70
|
|
|
OS ANTI-PHOSPHOLIPID ANTIBODY
|
Facility
|
IP
|
$296.25
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
30002012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.88 |
| Max. Negotiated Rate |
$284.40 |
| Rate for Payer: Aetna Commercial |
$228.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.89
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cigna Commercial |
$245.89
|
| Rate for Payer: First Health Commercial |
$281.44
|
| Rate for Payer: Humana Commercial |
$251.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.70
|
| Rate for Payer: Ohio Health Group HMO |
$222.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.41
|
| Rate for Payer: PHCS Commercial |
$284.40
|
| Rate for Payer: United Healthcare All Payer |
$260.70
|
|
|
OS ANTIPSYCHOTICS MH
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS 80343
|
| Hospital Charge Code |
30000105
|
|
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 ANTIPSYCHOTICS MH
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS 80343
|
| Hospital Charge Code |
30000105
|
|
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 ANTIPSYCHOTICS MH
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000105
|
|
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 ANTIPSYCHOTICS MH
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000105
|
|
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
|
|
|
OS ANTIPSYCHOTICS Paliperidone
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS 80342
|
| Hospital Charge Code |
30001991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$213.12 |
| Rate for Payer: Aetna Commercial |
$170.94
|
| Rate for Payer: Anthem Medicaid |
$76.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.27
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$184.26
|
| Rate for Payer: First Health Commercial |
$210.90
|
| Rate for Payer: Humana Commercial |
$188.70
|
| Rate for Payer: Humana KY Medicaid |
$76.35
|
| Rate for Payer: Kentucky WC Medicaid |
$77.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$195.36
|
| Rate for Payer: Ohio Health Group HMO |
$166.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.18
|
| Rate for Payer: PHCS Commercial |
$213.12
|
| Rate for Payer: United Healthcare All Payer |
$195.36
|
|
|
OS ANTIPSYCHOTICS Paliperidone
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS 80342
|
| Hospital Charge Code |
30001991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$213.12 |
| Rate for Payer: Aetna Commercial |
$170.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.27
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$184.26
|
| Rate for Payer: First Health Commercial |
$210.90
|
| Rate for Payer: Humana Commercial |
$188.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$195.36
|
| Rate for Payer: Ohio Health Group HMO |
$166.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.18
|
| Rate for Payer: PHCS Commercial |
$213.12
|
| Rate for Payer: United Healthcare All Payer |
$195.36
|
|
|
OS ANTIPSYCOTICSOTHER7 OR MORE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80344
|
| Hospital Charge Code |
30000106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$8.94
|
| Rate for Payer: Kentucky WC Medicaid |
$9.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS ANTIPSYCOTICSOTHER7 OR MORE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80344
|
| Hospital Charge Code |
30000106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Multiplan PHCS |
$15.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.20
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
|
|
OS ANTIPSYCOTICSOTHER7 OR MORE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS ANTIPSYCOTICSOTHER7 OR MORE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| 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 |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS ANTIPSYCOTICSOTHER7 OR MORE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80344
|
| Hospital Charge Code |
30000106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS ANTI SMOOTH MUSCLE AB TITER
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
30001023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
