|
OS MITOCHONDRIAL AB TITER
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
30001020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| 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 |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.67
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
OS MITOCHONDRIAL AB TITER
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
30001020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.07
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.67
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
OS MOG-IGG1 ANTB FLO CYTMTRY E
|
Facility
|
IP
|
$787.50
|
|
|
Service Code
|
HCPCS 86363
|
| Hospital Charge Code |
30002017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.36
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.12
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
OS MOG-IGG1 ANTB FLO CYTMTRY E
|
Facility
|
OP
|
$787.50
|
|
|
Service Code
|
HCPCS 86363
|
| Hospital Charge Code |
30002017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem Medicaid |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$52.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.73
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| 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 |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.12
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
OSMOLALITY SERUM
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
30000462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OSMOLALITY SERUM
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
30000462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$6.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.61
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$6.61
|
| Rate for Payer: Humana Medicare Advantage |
$6.61
|
| Rate for Payer: Kentucky WC Medicaid |
$6.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OSMOLALITY URINE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
30000463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$6.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$6.82
|
| Rate for Payer: Humana Medicare Advantage |
$6.82
|
| Rate for Payer: Kentucky WC Medicaid |
$6.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
OSMOLALITY URINE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
30000463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
OS MOLD PANEL IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000917
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS MOLD PANEL IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000917
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS MOLECLA CYTOGNTIS EA PRBE1
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
OS MOLECLA CYTOGNTIS EA PRBE1
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
OS MOLECLA CYTOGNTIS EA PRBE2
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
OS MOLECLA CYTOGNTIS EA PRBE2
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
OSMOLITE 1.2CAL 1000ML
|
Facility
|
IP
|
$91.19
|
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$87.54 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.13
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cigna Commercial |
$75.69
|
| Rate for Payer: First Health Commercial |
$86.63
|
| Rate for Payer: Humana Commercial |
$77.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.25
|
| Rate for Payer: Ohio Health Group HMO |
$68.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.27
|
| Rate for Payer: PHCS Commercial |
$87.54
|
| Rate for Payer: United Healthcare All Payer |
$80.25
|
|
|
OSMOLITE 1.2CAL 1000ML
|
Facility
|
OP
|
$70.44
|
|
|
Service Code
|
NDC 70074062698
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$67.62 |
| Rate for Payer: Aetna Commercial |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$24.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.94
|
| Rate for Payer: Cash Price |
$35.22
|
| Rate for Payer: Cigna Commercial |
$58.47
|
| Rate for Payer: First Health Commercial |
$66.92
|
| Rate for Payer: Humana Commercial |
$59.87
|
| Rate for Payer: Humana KY Medicaid |
$24.22
|
| Rate for Payer: Kentucky WC Medicaid |
$24.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.99
|
| Rate for Payer: Ohio Health Group HMO |
$52.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.84
|
| Rate for Payer: PHCS Commercial |
$67.62
|
| Rate for Payer: United Healthcare All Payer |
$61.99
|
|
|
OSMOLITE 1.2CAL 1000ML
|
Facility
|
IP
|
$70.44
|
|
|
Service Code
|
NDC 70074062698
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$67.62 |
| Rate for Payer: Aetna Commercial |
$54.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.94
|
| Rate for Payer: Cash Price |
$35.22
|
| Rate for Payer: Cigna Commercial |
$58.47
|
| Rate for Payer: First Health Commercial |
$66.92
|
| Rate for Payer: Humana Commercial |
$59.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.99
|
| Rate for Payer: Ohio Health Group HMO |
$52.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.84
|
| Rate for Payer: PHCS Commercial |
$67.62
|
| Rate for Payer: United Healthcare All Payer |
$61.99
|
|
|
OSMOLITE 1.2CAL 1000ML
|
Facility
|
OP
|
$91.19
|
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$87.54 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Anthem Medicaid |
$31.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.13
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cigna Commercial |
$75.69
|
| Rate for Payer: First Health Commercial |
$86.63
|
| Rate for Payer: Humana Commercial |
$77.51
|
| Rate for Payer: Humana KY Medicaid |
$31.36
|
| Rate for Payer: Kentucky WC Medicaid |
$31.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.25
|
| Rate for Payer: Ohio Health Group HMO |
$68.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.27
|
| Rate for Payer: PHCS Commercial |
$87.54
|
| Rate for Payer: United Healthcare All Payer |
$80.25
|
|
|
OSMOLITE 1 CAL 1000ML
|
Facility
|
IP
|
$91.19
|
|
| Hospital Charge Code |
27000239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$87.54 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.13
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cigna Commercial |
$75.69
|
| Rate for Payer: First Health Commercial |
$86.63
|
| Rate for Payer: Humana Commercial |
$77.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.25
|
| Rate for Payer: Ohio Health Group HMO |
$68.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.27
|
| Rate for Payer: PHCS Commercial |
$87.54
|
| Rate for Payer: United Healthcare All Payer |
$80.25
|
|
|
OSMOLITE 1 CAL 1000ML
|
Facility
|
OP
|
$91.19
|
|
| Hospital Charge Code |
27000239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$87.54 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Anthem Medicaid |
$31.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.13
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cigna Commercial |
$75.69
|
| Rate for Payer: First Health Commercial |
$86.63
|
| Rate for Payer: Humana Commercial |
$77.51
|
| Rate for Payer: Humana KY Medicaid |
$31.36
|
| Rate for Payer: Kentucky WC Medicaid |
$31.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.25
|
| Rate for Payer: Ohio Health Group HMO |
$68.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.27
|
| Rate for Payer: PHCS Commercial |
$87.54
|
| Rate for Payer: United Healthcare All Payer |
$80.25
|
|
|
OSMOLITE 1 CAL 1000ML
|
Facility
|
OP
|
$69.69
|
|
|
Service Code
|
NDC 70074062692
|
| Hospital Charge Code |
27000239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$66.90 |
| Rate for Payer: Aetna Commercial |
$53.66
|
| Rate for Payer: Anthem Medicaid |
$23.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.36
|
| Rate for Payer: Cash Price |
$34.84
|
| Rate for Payer: Cigna Commercial |
$57.84
|
| Rate for Payer: First Health Commercial |
$66.21
|
| Rate for Payer: Humana Commercial |
$59.24
|
| Rate for Payer: Humana KY Medicaid |
$23.97
|
| Rate for Payer: Kentucky WC Medicaid |
$24.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.33
|
| Rate for Payer: Ohio Health Group HMO |
$52.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.60
|
| Rate for Payer: PHCS Commercial |
$66.90
|
| Rate for Payer: United Healthcare All Payer |
$61.33
|
|
|
OSMOLITE 1 CAL 1000ML
|
Facility
|
IP
|
$69.69
|
|
|
Service Code
|
NDC 70074062692
|
| Hospital Charge Code |
27000239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$66.90 |
| Rate for Payer: Aetna Commercial |
$53.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.36
|
| Rate for Payer: Cash Price |
$34.84
|
| Rate for Payer: Cigna Commercial |
$57.84
|
| Rate for Payer: First Health Commercial |
$66.21
|
| Rate for Payer: Humana Commercial |
$59.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.33
|
| Rate for Payer: Ohio Health Group HMO |
$52.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.60
|
| Rate for Payer: PHCS Commercial |
$66.90
|
| Rate for Payer: United Healthcare All Payer |
$61.33
|
|
|
OS MONKEYPOX VIRUS EACH
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 87593
|
| Hospital Charge Code |
30002030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
OS MONKEYPOX VIRUS EACH
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 87593
|
| Hospital Charge Code |
30002030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
OS MOPATH PROCEDURE LEVEL 1
|
Facility
|
OP
|
$548.70
|
|
|
Service Code
|
HCPCS 81400
|
| Hospital Charge Code |
30002018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$526.75 |
| Rate for Payer: Aetna Commercial |
$422.50
|
| Rate for Payer: Anthem Medicaid |
$63.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$63.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$89.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.96
|
| Rate for Payer: Cash Price |
$274.35
|
| Rate for Payer: Cash Price |
$274.35
|
| Rate for Payer: Cigna Commercial |
$455.42
|
| Rate for Payer: First Health Commercial |
$521.26
|
| Rate for Payer: Humana Commercial |
$466.40
|
| Rate for Payer: Humana KY Medicaid |
$63.96
|
| Rate for Payer: Humana Medicare Advantage |
$63.96
|
| Rate for Payer: Kentucky WC Medicaid |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.86
|
| Rate for Payer: Ohio Health Group HMO |
$411.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.10
|
| Rate for Payer: PHCS Commercial |
$526.75
|
| Rate for Payer: United Healthcare All Payer |
$482.86
|
|
