|
OS CLONAZEPAM S
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$210.24 |
| Rate for Payer: Aetna Commercial |
$168.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.86
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cigna Commercial |
$181.77
|
| Rate for Payer: First Health Commercial |
$208.05
|
| Rate for Payer: Humana Commercial |
$186.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$179.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$192.72
|
| Rate for Payer: Ohio Health Group HMO |
$164.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.11
|
| Rate for Payer: PHCS Commercial |
$210.24
|
| Rate for Payer: United Healthcare All Payer |
$192.72
|
|
|
OS CLONAZEPAM S
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$210.24 |
| Rate for Payer: Aetna Commercial |
$168.63
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cigna Commercial |
$181.77
|
| Rate for Payer: First Health Commercial |
$208.05
|
| Rate for Payer: Humana Commercial |
$186.15
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$179.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$192.72
|
| Rate for Payer: Ohio Health Group HMO |
$164.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.11
|
| Rate for Payer: PHCS Commercial |
$210.24
|
| Rate for Payer: United Healthcare All Payer |
$192.72
|
|
|
OS CLONAZEPAM S
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$210.24 |
| Rate for Payer: Aetna Commercial |
$168.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.86
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cigna Commercial |
$181.77
|
| Rate for Payer: First Health Commercial |
$208.05
|
| Rate for Payer: Humana Commercial |
$186.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$179.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$192.72
|
| Rate for Payer: Ohio Health Group HMO |
$164.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.11
|
| Rate for Payer: PHCS Commercial |
$210.24
|
| Rate for Payer: United Healthcare All Payer |
$192.72
|
|
|
OS CLOT INHIBIT PROT C ACIV
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
30000592
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$254.87
|
| Rate for Payer: Anthem Medicaid |
$13.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.84
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$274.73
|
| Rate for Payer: First Health Commercial |
$314.45
|
| Rate for Payer: Humana Commercial |
$281.35
|
| Rate for Payer: Humana KY Medicaid |
$13.84
|
| Rate for Payer: Humana Medicare Advantage |
$13.84
|
| Rate for Payer: Kentucky WC Medicaid |
$13.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$271.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$244.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$291.28
|
| Rate for Payer: Ohio Health Group HMO |
$248.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.39
|
| Rate for Payer: PHCS Commercial |
$317.76
|
| Rate for Payer: United Healthcare All Payer |
$291.28
|
|
|
OS CLOT INHIBIT PROT C ACIV
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
30000592
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$254.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.79
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$274.73
|
| Rate for Payer: First Health Commercial |
$314.45
|
| Rate for Payer: Humana Commercial |
$281.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$271.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$244.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$291.28
|
| Rate for Payer: Ohio Health Group HMO |
$248.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.39
|
| Rate for Payer: PHCS Commercial |
$317.76
|
| Rate for Payer: United Healthcare All Payer |
$291.28
|
|
|
OS CLOVE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS CLOVE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS CLOZAPINE S
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
HCPCS 80159
|
| Hospital Charge Code |
30000024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$194.88 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.01
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cigna Commercial |
$168.49
|
| Rate for Payer: First Health Commercial |
$192.85
|
| Rate for Payer: Humana Commercial |
$172.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.64
|
| Rate for Payer: Ohio Health Group HMO |
$152.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.07
|
| Rate for Payer: PHCS Commercial |
$194.88
|
| Rate for Payer: United Healthcare All Payer |
$178.64
|
|
|
OS CLOZAPINE S
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
HCPCS 80159
|
| Hospital Charge Code |
30000024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$194.88 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.15
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cigna Commercial |
$168.49
|
| Rate for Payer: First Health Commercial |
$192.85
|
| Rate for Payer: Humana Commercial |
$172.55
|
| Rate for Payer: Humana KY Medicaid |
$20.15
|
| Rate for Payer: Humana Medicare Advantage |
$20.15
|
| Rate for Payer: Kentucky WC Medicaid |
$20.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.64
|
| Rate for Payer: Ohio Health Group HMO |
$152.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.07
|
| Rate for Payer: PHCS Commercial |
$194.88
|
| Rate for Payer: United Healthcare All Payer |
$178.64
|
|
|
OS CMV DNA DETECT/QUANT P
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
30001370
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$581.76 |
| Rate for Payer: Aetna Commercial |
$466.62
|
| Rate for Payer: Anthem Medicaid |
$42.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$486.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.84
|
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Cigna Commercial |
$502.98
|
| Rate for Payer: First Health Commercial |
$575.70
|
| Rate for Payer: Humana Commercial |
$515.10
|
| Rate for Payer: Humana KY Medicaid |
$42.84
|
| Rate for Payer: Humana Medicare Advantage |
$42.84
|
| Rate for Payer: Kentucky WC Medicaid |
$43.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$496.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$447.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$533.28
|
| Rate for Payer: Ohio Health Group HMO |
$454.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.14
|
| Rate for Payer: PHCS Commercial |
$581.76
|
| Rate for Payer: United Healthcare All Payer |
$533.28
|
|
|
OS CMV DNA DETECT/QUANT P
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
30001370
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$581.76 |
| Rate for Payer: Aetna Commercial |
$466.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$486.62
|
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Cigna Commercial |
$502.98
|
| Rate for Payer: First Health Commercial |
$575.70
|
| Rate for Payer: Humana Commercial |
$515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$496.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$447.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$533.28
|
| Rate for Payer: Ohio Health Group HMO |
$454.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.14
|
| Rate for Payer: PHCS Commercial |
$581.76
|
| Rate for Payer: United Healthcare All Payer |
$533.28
|
|
|
OS COAG FACTOR II ASSAY P
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
30000576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$310.08 |
| Rate for Payer: Aetna Commercial |
$248.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.37
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$268.09
|
| Rate for Payer: First Health Commercial |
$306.85
|
| Rate for Payer: Humana Commercial |
$274.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.24
|
| Rate for Payer: Ohio Health Group HMO |
$242.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.87
|
| Rate for Payer: PHCS Commercial |
$310.08
|
| Rate for Payer: United Healthcare All Payer |
$284.24
|
|
|
OS COAG FACTOR II ASSAY P
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
30000576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$310.08 |
| Rate for Payer: Aetna Commercial |
$248.71
|
| Rate for Payer: Anthem Medicaid |
$12.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.98
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$268.09
|
| Rate for Payer: First Health Commercial |
$306.85
|
| Rate for Payer: Humana Commercial |
$274.55
|
| Rate for Payer: Humana KY Medicaid |
$12.98
|
| Rate for Payer: Humana Medicare Advantage |
$12.98
|
| Rate for Payer: Kentucky WC Medicaid |
$13.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.24
|
| Rate for Payer: Ohio Health Group HMO |
$242.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.87
|
| Rate for Payer: PHCS Commercial |
$310.08
|
| Rate for Payer: United Healthcare All Payer |
$284.24
|
|
|
OS COAG FACTOR IX ASSAY P
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
30000583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$448.32 |
| Rate for Payer: Aetna Commercial |
$359.59
|
| Rate for Payer: Anthem Medicaid |
$19.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.04
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cigna Commercial |
$387.61
|
| Rate for Payer: First Health Commercial |
$443.65
|
| Rate for Payer: Humana Commercial |
$396.95
|
| Rate for Payer: Humana KY Medicaid |
$19.04
|
| Rate for Payer: Humana Medicare Advantage |
$19.04
|
| Rate for Payer: Kentucky WC Medicaid |
$19.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.96
|
| Rate for Payer: Ohio Health Group HMO |
$350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.23
|
| Rate for Payer: PHCS Commercial |
$448.32
|
| Rate for Payer: United Healthcare All Payer |
$410.96
|
|
|
OS COAG FACTOR IX ASSAY P
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
30000583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.10 |
| Max. Negotiated Rate |
$448.32 |
| Rate for Payer: Aetna Commercial |
$359.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.00
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cigna Commercial |
$387.61
|
| Rate for Payer: First Health Commercial |
$443.65
|
| Rate for Payer: Humana Commercial |
$396.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.96
|
| Rate for Payer: Ohio Health Group HMO |
$350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.23
|
| Rate for Payer: PHCS Commercial |
$448.32
|
| Rate for Payer: United Healthcare All Payer |
$410.96
|
|
|
OS COAG FACTOR V ASSAY P
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
30000577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem Medicaid |
$17.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.65
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Humana KY Medicaid |
$17.65
|
| Rate for Payer: Humana Medicare Advantage |
$17.65
|
| Rate for Payer: Kentucky WC Medicaid |
$17.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.63
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
OS COAG FACTOR V ASSAY P
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
30000577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.58
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.63
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
OS COAG FACTOR VII ASSAY P
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
30000578
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$443.52 |
| Rate for Payer: Aetna Commercial |
$355.74
|
| Rate for Payer: Anthem Medicaid |
$17.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.90
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$383.46
|
| Rate for Payer: First Health Commercial |
$438.90
|
| Rate for Payer: Humana Commercial |
$392.70
|
| Rate for Payer: Humana KY Medicaid |
$17.90
|
| Rate for Payer: Humana Medicare Advantage |
$17.90
|
| Rate for Payer: Kentucky WC Medicaid |
$18.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$406.56
|
| Rate for Payer: Ohio Health Group HMO |
$346.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.78
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
OS COAG FACTOR VII ASSAY P
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
30000578
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$443.52 |
| Rate for Payer: Aetna Commercial |
$355.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.99
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$383.46
|
| Rate for Payer: First Health Commercial |
$438.90
|
| Rate for Payer: Humana Commercial |
$392.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$406.56
|
| Rate for Payer: Ohio Health Group HMO |
$346.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.78
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
OS COAG FACTOR VIII ACTI ASSA
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
30000579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.70 |
| Max. Negotiated Rate |
$306.24 |
| Rate for Payer: Aetna Commercial |
$245.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$264.77
|
| Rate for Payer: First Health Commercial |
$303.05
|
| Rate for Payer: Humana Commercial |
$271.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$280.72
|
| Rate for Payer: Ohio Health Group HMO |
$239.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.11
|
| Rate for Payer: PHCS Commercial |
$306.24
|
| Rate for Payer: United Healthcare All Payer |
$280.72
|
|
|
OS COAG FACTOR VIII ACTI ASSA
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
30000579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$306.24 |
| Rate for Payer: Aetna Commercial |
$245.63
|
| Rate for Payer: Anthem Medicaid |
$17.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.90
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$264.77
|
| Rate for Payer: First Health Commercial |
$303.05
|
| Rate for Payer: Humana Commercial |
$271.15
|
| Rate for Payer: Humana KY Medicaid |
$17.90
|
| Rate for Payer: Humana Medicare Advantage |
$17.90
|
| Rate for Payer: Kentucky WC Medicaid |
$18.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$280.72
|
| Rate for Payer: Ohio Health Group HMO |
$239.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.11
|
| Rate for Payer: PHCS Commercial |
$306.24
|
| Rate for Payer: United Healthcare All Payer |
$280.72
|
|
|
OS COAG FACTOR X ASSAY
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
30000584
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem Medicaid |
$17.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.90
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Humana KY Medicaid |
$17.90
|
| Rate for Payer: Humana Medicare Advantage |
$17.90
|
| Rate for Payer: Kentucky WC Medicaid |
$18.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.24
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
OS COAG FACTOR X ASSAY
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
30000584
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.69
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.24
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
OS COAG FACTOR XI ASSAY P
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
30000585
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.11
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
OS COAG FACTOR XI ASSAY P
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
30000585
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$17.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.90
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$17.90
|
| Rate for Payer: Humana Medicare Advantage |
$17.90
|
| Rate for Payer: Kentucky WC Medicaid |
$18.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
