|
OS OXYCODONE URINE QUANT
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$288.96 |
| Rate for Payer: Aetna Commercial |
$231.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.70
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cigna Commercial |
$249.83
|
| Rate for Payer: First Health Commercial |
$285.95
|
| Rate for Payer: Humana Commercial |
$255.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.88
|
| Rate for Payer: Ohio Health Group HMO |
$225.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.31
|
| Rate for Payer: PHCS Commercial |
$288.96
|
| Rate for Payer: United Healthcare All Payer |
$264.88
|
|
|
OS PAI-1 Antigen
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 85415
|
| Hospital Charge Code |
30001974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$17.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.19
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$17.19
|
| Rate for Payer: Humana Medicare Advantage |
$17.19
|
| Rate for Payer: Kentucky WC Medicaid |
$17.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS PAI-1 Antigen
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 85415
|
| Hospital Charge Code |
30001974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS PANCA
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$85.44 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.47
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$73.87
|
| Rate for Payer: First Health Commercial |
$84.55
|
| Rate for Payer: Humana Commercial |
$75.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$78.32
|
| Rate for Payer: Ohio Health Group HMO |
$66.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.59
|
| Rate for Payer: PHCS Commercial |
$85.44
|
| Rate for Payer: United Healthcare All Payer |
$78.32
|
|
|
OS PANCA
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$85.44 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$73.87
|
| Rate for Payer: First Health Commercial |
$84.55
|
| Rate for Payer: Humana Commercial |
$75.65
|
| 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 |
$72.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$78.32
|
| Rate for Payer: Ohio Health Group HMO |
$66.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.59
|
| Rate for Payer: PHCS Commercial |
$85.44
|
| Rate for Payer: United Healthcare All Payer |
$78.32
|
|
|
OS PANCA IGG
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 88350
|
| Hospital Charge Code |
30001530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$58.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$58.81
|
| Rate for Payer: Kentucky WC Medicaid |
$59.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
OS PANCA IGG
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 88350
|
| Hospital Charge Code |
30001530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
OS Pantoth Acid (B-5) Bioassay
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
30001907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$127.68 |
| Rate for Payer: Aetna Commercial |
$102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.80
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$110.39
|
| Rate for Payer: First Health Commercial |
$126.35
|
| Rate for Payer: Humana Commercial |
$113.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.04
|
| Rate for Payer: Ohio Health Group HMO |
$99.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.23
|
| Rate for Payer: PHCS Commercial |
$127.68
|
| Rate for Payer: United Healthcare All Payer |
$117.04
|
|
|
OS Pantoth Acid (B-5) Bioassay
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
30001907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$127.68 |
| Rate for Payer: Aetna Commercial |
$102.41
|
| Rate for Payer: Anthem Medicaid |
$17.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.06
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$110.39
|
| Rate for Payer: First Health Commercial |
$126.35
|
| Rate for Payer: Humana Commercial |
$113.05
|
| Rate for Payer: Humana KY Medicaid |
$17.06
|
| Rate for Payer: Humana Medicare Advantage |
$17.06
|
| Rate for Payer: Kentucky WC Medicaid |
$17.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.04
|
| Rate for Payer: Ohio Health Group HMO |
$99.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.23
|
| Rate for Payer: PHCS Commercial |
$127.68
|
| Rate for Payer: United Healthcare All Payer |
$117.04
|
|
|
OS PAPAYA IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000878
|
|
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 PAPAYA IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000878
|
|
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 PARANEOPLAS AUTANT WBLOT S
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 84182
|
| Hospital Charge Code |
30000501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.88
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
OS PARANEOPLAS AUTANT WBLOT S
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 84182
|
| Hospital Charge Code |
30000501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.21 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem Medicaid |
$29.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$40.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.21
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Humana KY Medicaid |
$29.21
|
| Rate for Payer: Humana Medicare Advantage |
$29.21
|
| Rate for Payer: Kentucky WC Medicaid |
$29.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.88
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
OS PARATHYROID HORM REL PEPTI
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000271
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.20
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.54
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
OS PARATHYROID HORM REL PEPTI
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000271
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem Medicaid |
$14.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.12
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Humana KY Medicaid |
$14.12
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$14.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.54
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
OS PARIETAL CELL AB IGG S
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000374
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| 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 |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
OS PARIETAL CELL AB IGG S
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000374
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
OS PAROXETINE
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS 80332
|
| Hospital Charge Code |
30001949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.59 |
| Max. Negotiated Rate |
$137.28 |
| Rate for Payer: Aetna Commercial |
$110.11
|
| Rate for Payer: Anthem Medicaid |
$49.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.83
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$118.69
|
| Rate for Payer: First Health Commercial |
$135.85
|
| Rate for Payer: Humana Commercial |
$121.55
|
| Rate for Payer: Humana KY Medicaid |
$49.18
|
| Rate for Payer: Kentucky WC Medicaid |
$49.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$117.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$105.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$125.84
|
| Rate for Payer: Ohio Health Group HMO |
$107.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.33
|
| Rate for Payer: PHCS Commercial |
$137.28
|
| Rate for Payer: United Healthcare All Payer |
$125.84
|
|
|
OS PAROXETINE
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS 80332
|
| Hospital Charge Code |
30001949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.59 |
| Max. Negotiated Rate |
$137.28 |
| Rate for Payer: Aetna Commercial |
$110.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.83
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$118.69
|
| Rate for Payer: First Health Commercial |
$135.85
|
| Rate for Payer: Humana Commercial |
$121.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$117.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$105.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$125.84
|
| Rate for Payer: Ohio Health Group HMO |
$107.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.33
|
| Rate for Payer: PHCS Commercial |
$137.28
|
| Rate for Payer: United Healthcare All Payer |
$125.84
|
|
|
OS PAROXETINE SERUM
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30000059
|
|
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 PAROXETINE SERUM
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30000059
|
|
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 PARSLEY IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000749
|
|
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 PARSLEY IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000749
|
|
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 PARVOVIRUS B19 AB IGG
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
30001199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.98
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
OS PARVOVIRUS B19 AB IGG
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
30001199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem Medicaid |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.03
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Humana KY Medicaid |
$15.03
|
| Rate for Payer: Humana Medicare Advantage |
$15.03
|
| Rate for Payer: Kentucky WC Medicaid |
$15.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
