|
OS BETA 2 GP1 AB IGM S
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
30000984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.08
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
OS BETA 2 GP1 AB IGM S
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
30000984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Humana KY Medicaid |
$25.45
|
| Rate for Payer: Humana Medicare Advantage |
$25.45
|
| Rate for Payer: Kentucky WC Medicaid |
$25.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.08
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
OS BETA 2 MICROLOBULIN S
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
30000244
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS BETA 2 MICROLOBULIN S
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
30000244
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem Medicaid |
$16.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.18
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Humana KY Medicaid |
$16.18
|
| Rate for Payer: Humana Medicare Advantage |
$16.18
|
| Rate for Payer: Kentucky WC Medicaid |
$16.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS BETA-AM RATIO(1-42/1-40)CSF
|
Facility
|
IP
|
$1,141.80
|
|
|
Service Code
|
HCPCS 0358U
|
| Hospital Charge Code |
30002080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$342.54 |
| Max. Negotiated Rate |
$1,096.13 |
| Rate for Payer: Aetna Commercial |
$879.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.87
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna Commercial |
$947.69
|
| Rate for Payer: First Health Commercial |
$1,084.71
|
| Rate for Payer: Humana Commercial |
$970.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$936.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$842.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,004.78
|
| Rate for Payer: Ohio Health Group HMO |
$856.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$913.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$993.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$787.84
|
| Rate for Payer: PHCS Commercial |
$1,096.13
|
| Rate for Payer: United Healthcare All Payer |
$1,004.78
|
|
|
OS BETA-AM RATIO(1-42/1-40)CSF
|
Facility
|
OP
|
$1,141.80
|
|
|
Service Code
|
HCPCS 0358U
|
| Hospital Charge Code |
30002080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$260.50 |
| Max. Negotiated Rate |
$1,096.13 |
| Rate for Payer: Aetna Commercial |
$879.19
|
| Rate for Payer: Anthem Medicaid |
$260.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$260.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$364.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$260.50
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna Commercial |
$947.69
|
| Rate for Payer: First Health Commercial |
$1,084.71
|
| Rate for Payer: Humana Commercial |
$970.53
|
| Rate for Payer: Humana KY Medicaid |
$260.50
|
| Rate for Payer: Humana Medicare Advantage |
$260.50
|
| Rate for Payer: Kentucky WC Medicaid |
$263.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$936.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$842.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,004.78
|
| Rate for Payer: Ohio Health Group HMO |
$856.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$913.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$993.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$787.84
|
| Rate for Payer: PHCS Commercial |
$1,096.13
|
| Rate for Payer: United Healthcare All Payer |
$1,004.78
|
|
|
OS BETA GLOBIN GENE DEL/DUP
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
HCPCS 81403
|
| Hospital Charge Code |
30000206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.57 |
| Max. Negotiated Rate |
$259.28 |
| Rate for Payer: Aetna Commercial |
$194.81
|
| Rate for Payer: Anthem Medicaid |
$185.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$259.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.20
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna Commercial |
$209.99
|
| Rate for Payer: First Health Commercial |
$240.35
|
| Rate for Payer: Humana Commercial |
$215.05
|
| Rate for Payer: Humana KY Medicaid |
$185.20
|
| Rate for Payer: Humana Medicare Advantage |
$185.20
|
| Rate for Payer: Kentucky WC Medicaid |
$187.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$207.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$186.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$222.64
|
| Rate for Payer: Ohio Health Group HMO |
$189.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.57
|
| Rate for Payer: PHCS Commercial |
$242.88
|
| Rate for Payer: United Healthcare All Payer |
$222.64
|
|
|
OS BETA GLOBIN GENE DEL/DUP
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS 81403
|
| Hospital Charge Code |
30000206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.90 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$194.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.16
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna Commercial |
$209.99
|
| Rate for Payer: First Health Commercial |
$240.35
|
| Rate for Payer: Humana Commercial |
$215.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$207.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$186.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$222.64
|
| Rate for Payer: Ohio Health Group HMO |
$189.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.57
|
| Rate for Payer: PHCS Commercial |
$242.88
|
| Rate for Payer: United Healthcare All Payer |
$222.64
|
|
|
OS BETA-HYDROXYBUTYRATE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
30000220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$8.17
|
| Rate for Payer: Humana Medicare Advantage |
$8.17
|
| Rate for Payer: Kentucky WC Medicaid |
$8.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
OS BETA-HYDROXYBUTYRATE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
30000220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
OS BETHESDA UNITS
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
30000597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.82
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
OS BETHESDA UNITS
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
30000597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem Medicaid |
$12.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.87
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Humana KY Medicaid |
$12.87
|
| Rate for Payer: Humana Medicare Advantage |
$12.87
|
| Rate for Payer: Kentucky WC Medicaid |
$13.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
OS B GARINII B AFZELII PCR
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001395
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$167.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$97.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
OS B GARINII B AFZELII PCR
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001395
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$214.83
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$231.57
|
| Rate for Payer: First Health Commercial |
$265.05
|
| Rate for Payer: Humana Commercial |
$237.15
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$228.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$245.52
|
| Rate for Payer: Ohio Health Group HMO |
$209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.51
|
| Rate for Payer: PHCS Commercial |
$267.84
|
| Rate for Payer: United Healthcare All Payer |
$245.52
|
|
|
OS B GARINII B AFZELII PCR
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001395
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$214.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.04
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$231.57
|
| Rate for Payer: First Health Commercial |
$265.05
|
| Rate for Payer: Humana Commercial |
$237.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$228.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$245.52
|
| Rate for Payer: Ohio Health Group HMO |
$209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.51
|
| Rate for Payer: PHCS Commercial |
$267.84
|
| Rate for Payer: United Healthcare All Payer |
$245.52
|
|
|
OS BILE ACIDS S
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
30000245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.31
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
|
OS BILE ACIDS S
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
30000245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem Medicaid |
$17.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.12
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Humana KY Medicaid |
$17.12
|
| Rate for Payer: Humana Medicare Advantage |
$17.12
|
| Rate for Payer: Kentucky WC Medicaid |
$17.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.31
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
|
OS BILIRUBIN TOTAL
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000247
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
OS BILIRUBIN TOTAL
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000247
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$5.02
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
OS BIOTINIDASE
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 82261
|
| Hospital Charge Code |
30001856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$16.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.87
|
| 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 |
$16.87
|
| Rate for Payer: Humana Medicare Advantage |
$16.87
|
| Rate for Payer: Kentucky WC Medicaid |
$17.04
|
| 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 |
$20.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.21
|
| 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 BIOTINIDASE
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 82261
|
| Hospital Charge Code |
30001856
|
|
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 BLACKBERRY IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000641
|
|
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 BLACKBERRY IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000641
|
|
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 BLACK/WHITE PEPPER IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000677
|
|
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 BLACK/WHITE PEPPER IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000677
|
|
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
|
|
