|
OS C3 COMPLEMNT ANTIG EA CMP
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000992
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.44
|
| 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: 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 |
$3.90
|
| 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
|
|
|
OS C4 COMPLEMENTS-EA COMP AGS
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000994
|
|
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 C4 COMPLEMENTS-EA COMP AGS
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000994
|
|
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 C4 COMPLEMN ANTIGEA COMP
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000989
|
|
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
|
|
|
OS C4 COMPLEMN ANTIGEA COMP
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.44
|
| 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: 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 |
$3.90
|
| 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
|
|
|
OS C5 COMPLEMENT ANTIGEN S
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000993
|
|
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 C5 COMPLEMENT ANTIGEN S
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
30000993
|
|
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 C5 COMPLEMENT FUNCTIONAL S
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
30000996
|
|
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 C5 COMPLEMENT FUNCTIONAL S
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
30000996
|
|
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 CA27-29 BREAST CARCINOMA AG
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
30001036
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$152.64 |
| Rate for Payer: Aetna Commercial |
$122.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.68
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$131.97
|
| Rate for Payer: First Health Commercial |
$151.05
|
| Rate for Payer: Humana Commercial |
$135.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$130.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$117.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.92
|
| Rate for Payer: Ohio Health Group HMO |
$119.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.71
|
| Rate for Payer: PHCS Commercial |
$152.64
|
| Rate for Payer: United Healthcare All Payer |
$139.92
|
|
|
OS CA27-29 BREAST CARCINOMA AG
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
30001036
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$152.64 |
| Rate for Payer: Aetna Commercial |
$122.43
|
| Rate for Payer: Anthem Medicaid |
$20.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$131.97
|
| Rate for Payer: First Health Commercial |
$151.05
|
| Rate for Payer: Humana Commercial |
$135.15
|
| Rate for Payer: Humana KY Medicaid |
$20.81
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Kentucky WC Medicaid |
$21.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$130.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$117.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.92
|
| Rate for Payer: Ohio Health Group HMO |
$119.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.71
|
| Rate for Payer: PHCS Commercial |
$152.64
|
| Rate for Payer: United Healthcare All Payer |
$139.92
|
|
|
OS CADMIUM B
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 82300
|
| Hospital Charge Code |
30000255
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem Medicaid |
$23.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.64
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Humana KY Medicaid |
$23.64
|
| Rate for Payer: Humana Medicare Advantage |
$23.64
|
| Rate for Payer: Kentucky WC Medicaid |
$23.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.76
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
OS CADMIUM B
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 82300
|
| Hospital Charge Code |
30000255
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.76
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
OS CAFFEINE S
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 80155
|
| Hospital Charge Code |
30000019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem Medicaid |
$38.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.57
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Humana KY Medicaid |
$38.57
|
| Rate for Payer: Humana Medicare Advantage |
$38.57
|
| Rate for Payer: Kentucky WC Medicaid |
$38.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.26
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
OS CAFFEINE S
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 80155
|
| Hospital Charge Code |
30000019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.26
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
OS CAL 500 +D TABLET
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 10006070038
|
| Hospital Charge Code |
25001143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
OS CAL 500 +D TABLET
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 10006070038
|
| Hospital Charge Code |
25001143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
OS CAL(CALCIUM PHOS 500MG/1TAB
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 904188361
|
| Hospital Charge Code |
25001144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.51
|
| Rate for Payer: First Health Commercial |
$4.02
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.72
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.92
|
| Rate for Payer: PHCS Commercial |
$4.06
|
| Rate for Payer: United Healthcare All Payer |
$3.72
|
|
|
OS CAL(CALCIUM PHOS 500MG/1TAB
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 904188361
|
| Hospital Charge Code |
25001144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.51
|
| Rate for Payer: First Health Commercial |
$4.02
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.72
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.92
|
| Rate for Payer: PHCS Commercial |
$4.06
|
| Rate for Payer: United Healthcare All Payer |
$3.72
|
|
|
OS CALC CHAN BIND AB N-TYPE
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 86596
|
| Hospital Charge Code |
30000389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$226.56 |
| Rate for Payer: Aetna Commercial |
$181.72
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$195.88
|
| Rate for Payer: First Health Commercial |
$224.20
|
| Rate for Payer: Humana Commercial |
$200.60
|
| 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 |
$193.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$207.68
|
| Rate for Payer: Ohio Health Group HMO |
$177.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.84
|
| Rate for Payer: PHCS Commercial |
$226.56
|
| Rate for Payer: United Healthcare All Payer |
$207.68
|
|
|
OS CALC CHAN BIND AB N-TYPE
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 86596
|
| Hospital Charge Code |
30000389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$226.56 |
| Rate for Payer: Aetna Commercial |
$181.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.51
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$195.88
|
| Rate for Payer: First Health Commercial |
$224.20
|
| Rate for Payer: Humana Commercial |
$200.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$193.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$207.68
|
| Rate for Payer: Ohio Health Group HMO |
$177.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.84
|
| Rate for Payer: PHCS Commercial |
$226.56
|
| Rate for Payer: United Healthcare All Payer |
$207.68
|
|
|
OS CALC CHAN BIND AB P/Q-TYPE
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 86596
|
| Hospital Charge Code |
30000387
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.76
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.95
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
OS CALC CHAN BIND AB P/Q-TYPE
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 86596
|
| Hospital Charge Code |
30000387
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| 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 |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.95
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
OS CALCITONIN
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
30000258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$290.88 |
| Rate for Payer: Aetna Commercial |
$233.31
|
| Rate for Payer: Anthem Medicaid |
$26.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$243.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.79
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$251.49
|
| Rate for Payer: First Health Commercial |
$287.85
|
| Rate for Payer: Humana Commercial |
$257.55
|
| Rate for Payer: Humana KY Medicaid |
$26.79
|
| Rate for Payer: Humana Medicare Advantage |
$26.79
|
| Rate for Payer: Kentucky WC Medicaid |
$27.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$248.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$223.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$266.64
|
| Rate for Payer: Ohio Health Group HMO |
$227.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$242.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.07
|
| Rate for Payer: PHCS Commercial |
$290.88
|
| Rate for Payer: United Healthcare All Payer |
$266.64
|
|
|
OS CALCITONIN
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
30000258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$290.88 |
| Rate for Payer: Aetna Commercial |
$233.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$243.31
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$251.49
|
| Rate for Payer: First Health Commercial |
$287.85
|
| Rate for Payer: Humana Commercial |
$257.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$248.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$223.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$266.64
|
| Rate for Payer: Ohio Health Group HMO |
$227.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$242.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.07
|
| Rate for Payer: PHCS Commercial |
$290.88
|
| Rate for Payer: United Healthcare All Payer |
$266.64
|
|
