|
OS NK CELLS TOTAL COUNT
|
Facility
|
OP
|
$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 Medicaid |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$52.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.73
|
| Rate for Payer: Cash Price |
$75.50
|
| 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: 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 |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.48
|
| 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
|
|
|
OS NKX2 3 SNP
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000213
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem Medicaid |
$62.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Humana KY Medicaid |
$62.59
|
| Rate for Payer: Kentucky WC Medicaid |
$63.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.42
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
OS NKX2 3 SNP
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000213
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.42
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
OS NMDA-R, LGI1 IGG CBA S
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$341.88
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$356.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$368.52
|
| Rate for Payer: First Health Commercial |
$421.80
|
| Rate for Payer: Humana Commercial |
$377.40
|
| 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 |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$327.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$390.72
|
| Rate for Payer: Ohio Health Group HMO |
$333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.64
|
| Rate for Payer: PHCS Commercial |
$426.24
|
| Rate for Payer: United Healthcare All Payer |
$390.72
|
|
|
OS NMDA-R, LGI1 IGG CBA S
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.72 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$341.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$356.53
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$368.52
|
| Rate for Payer: First Health Commercial |
$421.80
|
| Rate for Payer: Humana Commercial |
$377.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$327.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$390.72
|
| Rate for Payer: Ohio Health Group HMO |
$333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.64
|
| Rate for Payer: PHCS Commercial |
$426.24
|
| Rate for Payer: United Healthcare All Payer |
$390.72
|
|
|
OS NMR LIPOPROTEIN
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 83704
|
| Hospital Charge Code |
30000444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: Aetna Commercial |
$155.54
|
| Rate for Payer: Anthem Medicaid |
$34.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$162.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$47.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.19
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$167.66
|
| Rate for Payer: First Health Commercial |
$191.90
|
| Rate for Payer: Humana Commercial |
$171.70
|
| Rate for Payer: Humana KY Medicaid |
$34.19
|
| Rate for Payer: Humana Medicare Advantage |
$34.19
|
| Rate for Payer: Kentucky WC Medicaid |
$34.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.76
|
| Rate for Payer: Ohio Health Group HMO |
$151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.62
|
| Rate for Payer: PHCS Commercial |
$193.92
|
| Rate for Payer: United Healthcare All Payer |
$177.76
|
|
|
OS NMR LIPOPROTEIN
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 83704
|
| Hospital Charge Code |
30000444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: Aetna Commercial |
$155.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$162.21
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$167.66
|
| Rate for Payer: First Health Commercial |
$191.90
|
| Rate for Payer: Humana Commercial |
$171.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.76
|
| Rate for Payer: Ohio Health Group HMO |
$151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.62
|
| Rate for Payer: PHCS Commercial |
$193.92
|
| Rate for Payer: United Healthcare All Payer |
$177.76
|
|
|
OS NOD2 (SNP 8 12 13)
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
30000205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.56
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS NOD2 (SNP 8 12 13)
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
30000205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem Medicaid |
$137.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$191.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Humana KY Medicaid |
$137.00
|
| Rate for Payer: Humana Medicare Advantage |
$137.00
|
| Rate for Payer: Kentucky WC Medicaid |
$138.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.56
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS Non TB Mycobacteria PCR
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
HCPCS 87551
|
| Hospital Charge Code |
30001989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$468.48 |
| Rate for Payer: Aetna Commercial |
$375.76
|
| Rate for Payer: Anthem Medicaid |
$48.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$48.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$391.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$67.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.24
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cigna Commercial |
$405.04
|
| Rate for Payer: First Health Commercial |
$463.60
|
| Rate for Payer: Humana Commercial |
$414.80
|
| Rate for Payer: Humana KY Medicaid |
$48.24
|
| Rate for Payer: Humana Medicare Advantage |
$48.24
|
| Rate for Payer: Kentucky WC Medicaid |
$48.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$429.44
|
| Rate for Payer: Ohio Health Group HMO |
$366.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.28
|
| Rate for Payer: PHCS Commercial |
$468.48
|
| Rate for Payer: United Healthcare All Payer |
$429.44
|
|
|
OS Non TB Mycobacteria PCR
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
HCPCS 87551
|
| Hospital Charge Code |
30001989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.44 |
| Max. Negotiated Rate |
$468.48 |
| Rate for Payer: Aetna Commercial |
$375.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$391.86
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cigna Commercial |
$405.04
|
| Rate for Payer: First Health Commercial |
$463.60
|
| Rate for Payer: Humana Commercial |
$414.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$429.44
|
| Rate for Payer: Ohio Health Group HMO |
$366.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.28
|
| Rate for Payer: PHCS Commercial |
$468.48
|
| Rate for Payer: United Healthcare All Payer |
$429.44
|
|
|
OS NORCLOZAPINE S
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30000060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem Medicaid |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Humana KY Medicaid |
$18.64
|
| Rate for Payer: Humana Medicare Advantage |
$18.64
|
| Rate for Payer: Kentucky WC Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
OS NORCLOZAPINE S
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30000060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.16
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
OS NORTRIPTYLINE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS G6037
|
| Hospital Charge Code |
30001558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Anthem Medicaid |
$13.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.12
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$33.20
|
| Rate for Payer: First Health Commercial |
$38.00
|
| Rate for Payer: Humana Commercial |
$34.00
|
| Rate for Payer: Humana KY Medicaid |
$13.76
|
| Rate for Payer: Kentucky WC Medicaid |
$13.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.20
|
| Rate for Payer: Ohio Health Group HMO |
$30.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.40
|
| Rate for Payer: PHCS Commercial |
$38.40
|
| Rate for Payer: United Healthcare All Payer |
$35.20
|
|
|
OS NORTRIPTYLINE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS G6037
|
| Hospital Charge Code |
30001558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.12
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$33.20
|
| Rate for Payer: First Health Commercial |
$38.00
|
| Rate for Payer: Humana Commercial |
$34.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.20
|
| Rate for Payer: Ohio Health Group HMO |
$30.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.40
|
| Rate for Payer: PHCS Commercial |
$38.40
|
| Rate for Payer: United Healthcare All Payer |
$35.20
|
|
|
OS NORTRIPTYLINE SERUM
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
OS NORTRIPTYLINE SERUM
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| 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 |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
OS NSA INFLAM BOWEL DISEAS
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS NSA INFLAM BOWEL DISEAS
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS NTX TELOPEPTIDE
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
30000285
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$229.44 |
| Rate for Payer: Aetna Commercial |
$184.03
|
| Rate for Payer: Anthem Medicaid |
$18.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.68
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$198.37
|
| Rate for Payer: First Health Commercial |
$227.05
|
| Rate for Payer: Humana Commercial |
$203.15
|
| Rate for Payer: Humana KY Medicaid |
$18.68
|
| Rate for Payer: Humana Medicare Advantage |
$18.68
|
| Rate for Payer: Kentucky WC Medicaid |
$18.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$195.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$176.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$210.32
|
| Rate for Payer: Ohio Health Group HMO |
$179.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.09
|
| Rate for Payer: PHCS Commercial |
$229.44
|
| Rate for Payer: United Healthcare All Payer |
$210.32
|
|
|
OS NTX TELOPEPTIDE
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
30000285
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$229.44 |
| Rate for Payer: Aetna Commercial |
$184.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.92
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$198.37
|
| Rate for Payer: First Health Commercial |
$227.05
|
| Rate for Payer: Humana Commercial |
$203.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$195.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$176.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$210.32
|
| Rate for Payer: Ohio Health Group HMO |
$179.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.09
|
| Rate for Payer: PHCS Commercial |
$229.44
|
| Rate for Payer: United Healthcare All Payer |
$210.32
|
|
|
OS NUTMEG IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000756
|
|
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 NUTMEG IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000756
|
|
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 OATS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000856
|
|
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 OATS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000856
|
|
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
|
|
