|
OS ANTI SMOOTH MUSCLE AB TITER
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
30001023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| 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: 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 |
$48.90
|
| 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
|
|
|
OS ANTI SMOOT MUSCLE AB SCREN
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
30001015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| 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 |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
OS ANTI SMOOT MUSCLE AB SCREN
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
30001015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
OS ANTISTREP O ASO TITER QUANT
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
30000978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem Medicaid |
$7.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.30
|
| 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 |
$7.30
|
| Rate for Payer: Humana Medicare Advantage |
$7.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7.37
|
| 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 |
$8.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.45
|
| 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 ANTISTREP O ASO TITER QUANT
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
30000978
|
|
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 ANTITHROMBIN III ABP
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
30000589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Anthem Medicaid |
$10.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.81
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$234.06
|
| Rate for Payer: First Health Commercial |
$267.90
|
| Rate for Payer: Humana Commercial |
$239.70
|
| Rate for Payer: Humana KY Medicaid |
$10.81
|
| Rate for Payer: Humana Medicare Advantage |
$10.81
|
| Rate for Payer: Kentucky WC Medicaid |
$10.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$231.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$248.16
|
| Rate for Payer: Ohio Health Group HMO |
$211.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.58
|
| Rate for Payer: PHCS Commercial |
$270.72
|
| Rate for Payer: United Healthcare All Payer |
$248.16
|
|
|
OS ANTITHROMBIN III ABP
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
30000589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.45
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$234.06
|
| Rate for Payer: First Health Commercial |
$267.90
|
| Rate for Payer: Humana Commercial |
$239.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$231.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$248.16
|
| Rate for Payer: Ohio Health Group HMO |
$211.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.58
|
| Rate for Payer: PHCS Commercial |
$270.72
|
| Rate for Payer: United Healthcare All Payer |
$248.16
|
|
|
OS ANTITHROMBIN III ACTIVITY
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
30000588
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$189.12 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem Medicaid |
$11.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.85
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Humana KY Medicaid |
$11.85
|
| Rate for Payer: Humana Medicare Advantage |
$11.85
|
| Rate for Payer: Kentucky WC Medicaid |
$11.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.93
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
OS ANTITHROMBIN III ACTIVITY
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
30000588
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$189.12 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.19
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.93
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
OS APOE ALZHEIMER'S DIS RISK
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
30002070
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$116.10 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$310.76
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$336.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.03
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
OS APOE ALZHEIMER'S DIS RISK
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
30002070
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem Medicaid |
$137.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$310.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$191.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.00
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Humana KY Medicaid |
$137.00
|
| Rate for Payer: Humana Medicare Advantage |
$137.00
|
| Rate for Payer: Kentucky WC Medicaid |
$138.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$336.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.03
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
OS APOLIPROPROTEIN EACH
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
30000241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
OS APOLIPROPROTEIN EACH
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
30000241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem Medicaid |
$21.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.09
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Humana KY Medicaid |
$21.09
|
| Rate for Payer: Humana Medicare Advantage |
$21.09
|
| Rate for Payer: Kentucky WC Medicaid |
$21.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
OS APPLE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000842
|
|
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 APPLE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000842
|
|
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 APRICOT IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000948
|
|
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 APRICOT IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000948
|
|
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 APTT MIX 1:1
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
30000633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$6.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Humana KY Medicaid |
$6.47
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
OS APTT MIX 1:1
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
30000633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
OS AQAPRN-4 ANTB FLOCYTMTRY EA
|
Facility
|
OP
|
$525.09
|
|
|
Service Code
|
HCPCS 86053
|
| Hospital Charge Code |
30002015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$504.09 |
| Rate for Payer: Aetna Commercial |
$404.32
|
| Rate for Payer: Anthem Medicaid |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$52.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.73
|
| Rate for Payer: Cash Price |
$262.54
|
| Rate for Payer: Cash Price |
$262.54
|
| Rate for Payer: Cigna Commercial |
$435.82
|
| Rate for Payer: First Health Commercial |
$498.84
|
| Rate for Payer: Humana Commercial |
$446.33
|
| Rate for Payer: Humana KY Medicaid |
$37.73
|
| Rate for Payer: Humana Medicare Advantage |
$37.73
|
| Rate for Payer: Kentucky WC Medicaid |
$38.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.08
|
| Rate for Payer: Ohio Health Group HMO |
$393.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.31
|
| Rate for Payer: PHCS Commercial |
$504.09
|
| Rate for Payer: United Healthcare All Payer |
$462.08
|
|
|
OS AQAPRN-4 ANTB FLOCYTMTRY EA
|
Facility
|
IP
|
$525.09
|
|
|
Service Code
|
HCPCS 86053
|
| Hospital Charge Code |
30002015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.53 |
| Max. Negotiated Rate |
$504.09 |
| Rate for Payer: Aetna Commercial |
$404.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.65
|
| Rate for Payer: Cash Price |
$262.54
|
| Rate for Payer: Cigna Commercial |
$435.82
|
| Rate for Payer: First Health Commercial |
$498.84
|
| Rate for Payer: Humana Commercial |
$446.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.08
|
| Rate for Payer: Ohio Health Group HMO |
$393.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.31
|
| Rate for Payer: PHCS Commercial |
$504.09
|
| Rate for Payer: United Healthcare All Payer |
$462.08
|
|
|
OS ARGININE VASOPRESSIN
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
30000555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$33.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$33.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$47.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.94
|
| 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 |
$33.94
|
| Rate for Payer: Humana Medicare Advantage |
$33.94
|
| Rate for Payer: Kentucky WC Medicaid |
$34.28
|
| 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 |
$40.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.62
|
| 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
|
|
|
OS ARGININE VASOPRESSIN
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
30000555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| 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: 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 |
$48.90
|
| 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
|
|
|
OS ARSENIC URINE
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
30000242
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.43
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
|
OS ARSENIC URINE
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
30000242
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem Medicaid |
$18.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.97
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Humana KY Medicaid |
$18.97
|
| Rate for Payer: Humana Medicare Advantage |
$18.97
|
| Rate for Payer: Kentucky WC Medicaid |
$19.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.43
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
