|
OS Phospholip A2 Recept IFA, S
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30001905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$447.36 |
| Rate for Payer: Aetna Commercial |
$358.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.20
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cigna Commercial |
$386.78
|
| Rate for Payer: First Health Commercial |
$442.70
|
| Rate for Payer: Humana Commercial |
$396.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$343.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.08
|
| Rate for Payer: Ohio Health Group HMO |
$349.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.46
|
| Rate for Payer: PHCS Commercial |
$447.36
|
| Rate for Payer: United Healthcare All Payer |
$410.08
|
|
|
OS PHTHALIC ANHYDRIDE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000829
|
|
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 PHTHALIC ANHYDRIDE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000829
|
|
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 PIGEON FEATHERS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000795
|
|
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 PIGEON FEATHERS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000795
|
|
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 PIG EPITHELIUM IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000765
|
|
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 PIG EPITHELIUM IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000765
|
|
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 PITYROSPORUM ORBICULARIGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000913
|
|
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 PITYROSPORUM ORBICULARIGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000913
|
|
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 PLAICE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000805
|
|
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 PLAICE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000805
|
|
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 PLASMINOGEN ACTIVITY
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 85420
|
| Hospital Charge Code |
30000607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.24
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$175.96
|
| Rate for Payer: First Health Commercial |
$201.40
|
| Rate for Payer: Humana Commercial |
$180.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.56
|
| Rate for Payer: Ohio Health Group HMO |
$159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.72
|
| Rate for Payer: PHCS Commercial |
$203.52
|
| Rate for Payer: United Healthcare All Payer |
$186.56
|
|
|
OS PLASMINOGEN ACTIVITY
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 85420
|
| Hospital Charge Code |
30000607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Anthem Medicaid |
$6.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$175.96
|
| Rate for Payer: First Health Commercial |
$201.40
|
| Rate for Payer: Humana Commercial |
$180.20
|
| Rate for Payer: Humana KY Medicaid |
$6.53
|
| Rate for Payer: Humana Medicare Advantage |
$6.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.56
|
| Rate for Payer: Ohio Health Group HMO |
$159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.72
|
| Rate for Payer: PHCS Commercial |
$203.52
|
| Rate for Payer: United Healthcare All Payer |
$186.56
|
|
|
OS PLATELET ANTIBODY
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
30000971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$310.31
|
| Rate for Payer: Anthem Medicaid |
$18.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.37
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cigna Commercial |
$334.49
|
| Rate for Payer: First Health Commercial |
$382.85
|
| Rate for Payer: Humana Commercial |
$342.55
|
| Rate for Payer: Humana KY Medicaid |
$18.37
|
| Rate for Payer: Humana Medicare Advantage |
$18.37
|
| Rate for Payer: Kentucky WC Medicaid |
$18.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$330.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$297.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$354.64
|
| Rate for Payer: Ohio Health Group HMO |
$302.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.93
|
| Rate for Payer: PHCS Commercial |
$386.88
|
| Rate for Payer: United Healthcare All Payer |
$354.64
|
|
|
OS PLATELET ANTIBODY
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
30000971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$310.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.61
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cigna Commercial |
$334.49
|
| Rate for Payer: First Health Commercial |
$382.85
|
| Rate for Payer: Humana Commercial |
$342.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$330.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$297.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$354.64
|
| Rate for Payer: Ohio Health Group HMO |
$302.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.93
|
| Rate for Payer: PHCS Commercial |
$386.88
|
| Rate for Payer: United Healthcare All Payer |
$354.64
|
|
|
OS PLATELET NEUTRALIZATN PROC
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 85597
|
| Hospital Charge Code |
30000616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$17.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.98
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$17.98
|
| Rate for Payer: Humana Medicare Advantage |
$17.98
|
| Rate for Payer: Kentucky WC Medicaid |
$18.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
OS PLATELET NEUTRALIZATN PROC
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 85597
|
| Hospital Charge Code |
30000616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.19
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
OS PNEUMOCYSTIS CARINII AG IF
|
Facility
|
IP
|
$76.52
|
|
|
Service Code
|
HCPCS 87281
|
| Hospital Charge Code |
30002053
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$73.46 |
| Rate for Payer: Aetna Commercial |
$58.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.45
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cigna Commercial |
$63.51
|
| Rate for Payer: First Health Commercial |
$72.69
|
| Rate for Payer: Humana Commercial |
$65.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.34
|
| Rate for Payer: Ohio Health Group HMO |
$57.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.72
|
| Rate for Payer: PHCS Commercial |
$73.46
|
| Rate for Payer: United Healthcare All Payer |
$67.34
|
|
|
OS PNEUMOCYSTIS CARINII AG IF
|
Facility
|
OP
|
$76.52
|
|
|
Service Code
|
HCPCS 87281
|
| Hospital Charge Code |
30002053
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$73.46 |
| Rate for Payer: Aetna Commercial |
$58.92
|
| Rate for Payer: Anthem Medicaid |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cigna Commercial |
$63.51
|
| Rate for Payer: First Health Commercial |
$72.69
|
| Rate for Payer: Humana Commercial |
$65.04
|
| Rate for Payer: Humana KY Medicaid |
$11.98
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Kentucky WC Medicaid |
$12.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.34
|
| Rate for Payer: Ohio Health Group HMO |
$57.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.72
|
| Rate for Payer: PHCS Commercial |
$73.46
|
| Rate for Payer: United Healthcare All Payer |
$67.34
|
|
|
OS PORK IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000949
|
|
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 PORK IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000949
|
|
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 PORPHOBILINOGEN QUANT
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
30000477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.33 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$108.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.22
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$117.03
|
| Rate for Payer: First Health Commercial |
$133.95
|
| Rate for Payer: Humana Commercial |
$119.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$115.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.08
|
| Rate for Payer: Ohio Health Group HMO |
$105.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.71
|
| Rate for Payer: PHCS Commercial |
$135.36
|
| Rate for Payer: United Healthcare All Payer |
$124.08
|
|
|
OS PORPHOBILINOGEN QUANT
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
30000477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$108.57
|
| Rate for Payer: Anthem Medicaid |
$8.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.44
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$117.03
|
| Rate for Payer: First Health Commercial |
$133.95
|
| Rate for Payer: Humana Commercial |
$119.85
|
| Rate for Payer: Humana KY Medicaid |
$8.44
|
| Rate for Payer: Humana Medicare Advantage |
$8.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$115.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.08
|
| Rate for Payer: Ohio Health Group HMO |
$105.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.71
|
| Rate for Payer: PHCS Commercial |
$135.36
|
| Rate for Payer: United Healthcare All Payer |
$124.08
|
|
|
OS PORPHYRINS FRACTION PLASMA
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30000292
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.12
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$87.98
|
| Rate for Payer: First Health Commercial |
$100.70
|
| Rate for Payer: Humana Commercial |
$90.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$93.28
|
| Rate for Payer: Ohio Health Group HMO |
$79.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.86
|
| Rate for Payer: PHCS Commercial |
$101.76
|
| Rate for Payer: United Healthcare All Payer |
$93.28
|
|
|
OS PORPHYRINS FRACTION PLASMA
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30000292
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: Anthem Medicaid |
$24.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.09
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$87.98
|
| Rate for Payer: First Health Commercial |
$100.70
|
| Rate for Payer: Humana Commercial |
$90.10
|
| Rate for Payer: Humana KY Medicaid |
$24.09
|
| Rate for Payer: Humana Medicare Advantage |
$24.09
|
| Rate for Payer: Kentucky WC Medicaid |
$24.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$93.28
|
| Rate for Payer: Ohio Health Group HMO |
$79.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.86
|
| Rate for Payer: PHCS Commercial |
$101.76
|
| Rate for Payer: United Healthcare All Payer |
$93.28
|
|
