|
OS BUPRENORPHINE URINE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80348
|
| Hospital Charge Code |
30000116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Multiplan PHCS |
$15.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.20
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
|
|
OS BUPRENORPHINE URINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| 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: 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 |
$7.80
|
| 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 |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS BUPRENORPHINE URINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80348
|
| Hospital Charge Code |
30000116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| 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: 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 |
$7.80
|
| 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 |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS BUPRENORPHINE URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80348
|
| Hospital Charge Code |
30000116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| 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 |
$8.94
|
| Rate for Payer: Kentucky WC Medicaid |
$9.03
|
| 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 |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.12
|
| 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 |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS BUPRENORPHINE WB
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.17 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$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 |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS BUPRENORPHINE WB
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS BUPRENORPHINE WB
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 80348
|
| Hospital Charge Code |
30000119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$31.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$31.98
|
| Rate for Payer: Kentucky WC Medicaid |
$32.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS BUPRENORPHINE WB
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 80348
|
| Hospital Charge Code |
30000119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS BUPROPION VENLAFAXINE MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| 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: 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 |
$7.80
|
| 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 |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS BUPROPION VENLAFAXINE MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80338
|
| Hospital Charge Code |
30000099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| 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: 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 |
$7.80
|
| 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 |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS BUPROPION VENLAFAXINE MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80338
|
| Hospital Charge Code |
30000099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| 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 |
$8.94
|
| Rate for Payer: Kentucky WC Medicaid |
$9.03
|
| 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 |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.12
|
| 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 |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS BUPROPION VENLAFAXINE MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.94 |
| 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 |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS C1 ESTERASE INHIBITOR AG S
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
OS C1 ESTERASE INHIBITOR AG S
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
OS C1 ESTERAS INHIB FNC ASAY
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
30000995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$12.00
|
| Rate for Payer: Humana Medicare Advantage |
$12.00
|
| Rate for Payer: Kentucky WC Medicaid |
$12.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS C1 ESTERAS INHIB FNC ASAY
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
30000995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS C1Q COMPLEMENT FUNCT S
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
30000998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS C1Q COMPLEMENT FUNCT S
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
30000998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$12.00
|
| Rate for Payer: Humana Medicare Advantage |
$12.00
|
| Rate for Payer: Kentucky WC Medicaid |
$12.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS C1Q COMPLEMENT S
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.03
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.98
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
OS C1Q COMPLEMENT S
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem Medicaid |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Humana KY Medicaid |
$12.00
|
| Rate for Payer: Humana Medicare Advantage |
$12.00
|
| Rate for Payer: Kentucky WC Medicaid |
$12.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.98
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
OS C2 COMPLEMENT FUNCTIONAL S
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
30000997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$12.00
|
| Rate for Payer: Humana Medicare Advantage |
$12.00
|
| Rate for Payer: Kentucky WC Medicaid |
$12.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS C2 COMPLEMENT FUNCTIONAL S
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
30000997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS C3 COMPLEMENTS EA COMP AGS
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem Medicaid |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Humana KY Medicaid |
$12.00
|
| Rate for Payer: Humana Medicare Advantage |
$12.00
|
| Rate for Payer: Kentucky WC Medicaid |
$12.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.98
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
OS C3 COMPLEMENTS EA COMP AGS
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.03
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.98
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
OS C3 COMPLEMNT ANTIG EA CMP
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000992
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Humana KY Medicaid |
$12.00
|
| Rate for Payer: Humana Medicare Advantage |
$12.00
|
| Rate for Payer: Kentucky WC Medicaid |
$12.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.97
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
