|
OS MUSCLE RELAXANTS URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS MuSK Autoantibody
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
HCPCS 86366
|
| Hospital Charge Code |
30001862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$1,044.48 |
| Rate for Payer: Aetna Commercial |
$837.76
|
| Rate for Payer: Anthem Medicaid |
$18.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.40
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cigna Commercial |
$903.04
|
| Rate for Payer: First Health Commercial |
$1,033.60
|
| Rate for Payer: Humana Commercial |
$924.80
|
| Rate for Payer: Humana KY Medicaid |
$18.40
|
| Rate for Payer: Kentucky WC Medicaid |
$18.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$892.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$802.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$957.44
|
| Rate for Payer: Ohio Health Group HMO |
$816.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.28
|
| Rate for Payer: PHCS Commercial |
$1,044.48
|
| Rate for Payer: United Healthcare All Payer |
$957.44
|
|
|
OS MuSK Autoantibody
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
HCPCS 86366
|
| Hospital Charge Code |
30001862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.44 |
| Max. Negotiated Rate |
$1,044.48 |
| Rate for Payer: Aetna Commercial |
$837.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.66
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cigna Commercial |
$903.04
|
| Rate for Payer: First Health Commercial |
$1,033.60
|
| Rate for Payer: Humana Commercial |
$924.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$892.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$802.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$957.44
|
| Rate for Payer: Ohio Health Group HMO |
$816.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.28
|
| Rate for Payer: PHCS Commercial |
$1,044.48
|
| Rate for Payer: United Healthcare All Payer |
$957.44
|
|
|
OS MYCOBACTERIC IDENTIFICATION
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 87118
|
| Hospital Charge Code |
30001865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem Medicaid |
$14.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.61
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Humana KY Medicaid |
$14.61
|
| Rate for Payer: Humana Medicare Advantage |
$14.61
|
| Rate for Payer: Kentucky WC Medicaid |
$14.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.55
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
OS MYCOBACTERIC IDENTIFICATION
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 87118
|
| Hospital Charge Code |
30001865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.62
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.55
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
OS MYCOPHENOLIC ACID SERUM
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
HCPCS 80180
|
| Hospital Charge Code |
30000038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.39 |
| Max. Negotiated Rate |
$194.88 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.01
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cigna Commercial |
$168.49
|
| Rate for Payer: First Health Commercial |
$192.85
|
| Rate for Payer: Humana Commercial |
$172.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.64
|
| Rate for Payer: Ohio Health Group HMO |
$152.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.93
|
| Rate for Payer: PHCS Commercial |
$194.88
|
| Rate for Payer: United Healthcare All Payer |
$178.64
|
|
|
OS MYCOPHENOLIC ACID SERUM
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
HCPCS 80180
|
| Hospital Charge Code |
30000038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$194.88 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Anthem Medicaid |
$18.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.05
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cigna Commercial |
$168.49
|
| Rate for Payer: First Health Commercial |
$192.85
|
| Rate for Payer: Humana Commercial |
$172.55
|
| Rate for Payer: Humana KY Medicaid |
$18.05
|
| Rate for Payer: Humana Medicare Advantage |
$18.05
|
| Rate for Payer: Kentucky WC Medicaid |
$18.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.64
|
| Rate for Payer: Ohio Health Group HMO |
$152.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.93
|
| Rate for Payer: PHCS Commercial |
$194.88
|
| Rate for Payer: United Healthcare All Payer |
$178.64
|
|
|
OS MYCOPLASMA PNEUMONIAE IGM
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
30001197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.58 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.46
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS MYCOPLASMA PNEUMONIAE IGM
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
30001197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem Medicaid |
$13.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.24
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Humana KY Medicaid |
$13.24
|
| Rate for Payer: Humana Medicare Advantage |
$13.24
|
| Rate for Payer: Kentucky WC Medicaid |
$13.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.46
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS MYCOPLASMA PNEUMONIA IFA
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
30001196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem Medicaid |
$13.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.24
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Humana KY Medicaid |
$13.24
|
| Rate for Payer: Humana Medicare Advantage |
$13.24
|
| Rate for Payer: Kentucky WC Medicaid |
$13.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.46
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS MYCOPLASMA PNEUMONIA IFA
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
30001196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.58 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.46
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS MYCOPLASMA / UREAPLASMA PCR
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$207.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$124.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.90
|
| Rate for Payer: UHCCP Medicaid |
$72.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
OS MYCOPLASMA / UREAPLASMA PCR
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| 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 |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
OS MYCOPLASMA / UREAPLASMA PCR
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
OS MYELOPEROXIDASE AB S
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000384
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$11.53
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Kentucky WC Medicaid |
$11.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.94
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS MYELOPEROXIDASE AB S
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000384
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.94
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS MYOGLOBIN
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
30000453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.45
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
OS MYOGLOBIN
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
30000453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$12.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.92
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$12.92
|
| Rate for Payer: Humana Medicare Advantage |
$12.92
|
| Rate for Payer: Kentucky WC Medicaid |
$13.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
OS NEPHELOMETRY EACH
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
30000458
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$13.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Humana KY Medicaid |
$13.60
|
| Rate for Payer: Humana Medicare Advantage |
$13.60
|
| Rate for Payer: Kentucky WC Medicaid |
$13.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.81
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
OS NEPHELOMETRY EACH
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
30000458
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.81
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
OS NEURONAL V-G K+ CHANN AB S
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
30000388
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$18.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.40
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Humana KY Medicaid |
$18.40
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Kentucky WC Medicaid |
$18.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
OS NEURONAL V-G K+ CHANN AB S
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
30000388
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
OS NICOTINE & METABOLITES
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000080
|
|
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 Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| 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 |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| 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 NICOTINE & METABOLITES
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000080
|
|
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 NK CELLS TOTAL COUNT
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 86357
|
| Hospital Charge Code |
30001085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
