|
OS ASCA IGA
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000404
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$15.00
|
| 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: 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 |
$24.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| 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 ASCA IGA
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000404
|
|
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 ASCA IGG
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.11
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
OS ASCA IGG
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| 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 |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
OS ASCARIS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000874
|
|
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 ASCARIS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000874
|
|
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 ASCORBIC ACID (VIT C)BLOOD
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
30000243
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.76
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.95
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
OS ASCORBIC ACID (VIT C)BLOOD
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
30000243
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem Medicaid |
$9.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.89
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Humana KY Medicaid |
$9.89
|
| Rate for Payer: Humana Medicare Advantage |
$9.89
|
| Rate for Payer: Kentucky WC Medicaid |
$9.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.95
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
OS ASIOLO GM1 IGG
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
OS ASIOLO GM1 IGG
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| 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 |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
OS ASIOLO GM1 IGM
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
OS ASIOLO GM1 IGM
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| 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 |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
OS ASPA GENE
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 81200
|
| Hospital Charge Code |
30001910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$47.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$47.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$66.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.25
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Humana KY Medicaid |
$47.25
|
| Rate for Payer: Humana Medicare Advantage |
$47.25
|
| Rate for Payer: Kentucky WC Medicaid |
$47.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS ASPA GENE
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 81200
|
| Hospital Charge Code |
30001910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS ASPARAGUS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000745
|
|
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 ASPARAGUS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000745
|
|
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 ASPERGILLIS FUMIGATUS IGG
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
30001109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
OS ASPERGILLIS FUMIGATUS IGG
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
30001109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem Medicaid |
$15.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.05
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Humana KY Medicaid |
$15.05
|
| Rate for Payer: Humana Medicare Advantage |
$15.05
|
| Rate for Payer: Kentucky WC Medicaid |
$15.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
OS ASPERGILLUS ANTIGEN S
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
30001345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$222.72 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Anthem Medicaid |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$186.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna Commercial |
$192.56
|
| Rate for Payer: First Health Commercial |
$220.40
|
| Rate for Payer: Humana Commercial |
$197.20
|
| Rate for Payer: Humana KY Medicaid |
$11.98
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Kentucky WC Medicaid |
$12.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$190.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$204.16
|
| Rate for Payer: Ohio Health Group HMO |
$174.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.08
|
| Rate for Payer: PHCS Commercial |
$222.72
|
| Rate for Payer: United Healthcare All Payer |
$204.16
|
|
|
OS ASPERGILLUS ANTIGEN S
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
30001345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$222.72 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$186.30
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna Commercial |
$192.56
|
| Rate for Payer: First Health Commercial |
$220.40
|
| Rate for Payer: Humana Commercial |
$197.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$190.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$204.16
|
| Rate for Payer: Ohio Health Group HMO |
$174.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.08
|
| Rate for Payer: PHCS Commercial |
$222.72
|
| Rate for Payer: United Healthcare All Payer |
$204.16
|
|
|
OS ASPERGILLUS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000897
|
|
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 ASPERGILLUS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000897
|
|
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 ASSAY OF ACTH
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 82024
|
| Hospital Charge Code |
30000223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem Medicaid |
$38.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.62
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| 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 |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.55
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
OS ASSAY OF ACTH
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS 82024
|
| Hospital Charge Code |
30000223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.49
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.55
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
OS ASSAY OF CHROMIUM
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 82495
|
| Hospital Charge Code |
30001933
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem Medicaid |
$20.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.28
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Humana KY Medicaid |
$20.28
|
| Rate for Payer: Humana Medicare Advantage |
$20.28
|
| Rate for Payer: Kentucky WC Medicaid |
$20.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.55
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
