|
OSRAPAMYCIN (SIROLIMUS) BLD
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 80195
|
| Hospital Charge Code |
30000047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.57
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.90
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
OS RAPE SEED IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000694
|
|
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 RAPE SEED IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000694
|
|
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 RAPID PLASMA REAGIN S
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.18
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
OS RAPID PLASMA REAGIN S
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
OS RAT EPITHELIUM IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000807
|
|
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 RAT EPITHELIUM IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000807
|
|
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 RENIN ACTIVITY
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
30000506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.62
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.55
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
OS RENIN ACTIVITY
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
30000506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem Medicaid |
$21.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.99
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Humana KY Medicaid |
$21.99
|
| Rate for Payer: Humana Medicare Advantage |
$21.99
|
| Rate for Payer: Kentucky WC Medicaid |
$22.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.55
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
OS REPTILASE TIME
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 85635
|
| Hospital Charge Code |
30000624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$226.56 |
| Rate for Payer: Aetna Commercial |
$181.72
|
| Rate for Payer: Anthem Medicaid |
$9.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.85
|
| 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 |
$9.85
|
| Rate for Payer: Humana Medicare Advantage |
$9.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9.95
|
| 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 |
$11.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.05
|
| 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 |
$47.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.16
|
| Rate for Payer: PHCS Commercial |
$226.56
|
| Rate for Payer: United Healthcare All Payer |
$207.68
|
|
|
OS REPTILASE TIME
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 85635
|
| Hospital Charge Code |
30000624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.68 |
| 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 |
$47.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.16
|
| Rate for Payer: PHCS Commercial |
$226.56
|
| Rate for Payer: United Healthcare All Payer |
$207.68
|
|
|
OS RESPIR SYNCYTIAL VIR IGG
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86756
|
| Hospital Charge Code |
30001204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$15.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.89
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$15.89
|
| Rate for Payer: Humana Medicare Advantage |
$15.89
|
| Rate for Payer: Kentucky WC Medicaid |
$16.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS RESPIR SYNCYTIAL VIR IGG
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86756
|
| Hospital Charge Code |
30001204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS RESPIR SYNCYTIAL VIR IGM
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86756
|
| Hospital Charge Code |
30001203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$15.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.89
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$15.89
|
| Rate for Payer: Humana Medicare Advantage |
$15.89
|
| Rate for Payer: Kentucky WC Medicaid |
$16.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS RESPIR SYNCYTIAL VIR IGM
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86756
|
| Hospital Charge Code |
30001203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS RETICULIN ABS S
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$156.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$22.62
|
| Rate for Payer: Healthspan PPO |
$12.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.44
|
| Rate for Payer: Multiplan PHCS |
$93.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$109.20
|
| Rate for Payer: UHCCP Medicaid |
$54.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.23
|
|
|
OS RETICULIN ABS S
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| 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 |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS RETICULIN ABS S
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS RHEUMATOID FACTOR IGA
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.91
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
OS RHEUMATOID FACTOR IGA
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem Medicaid |
$5.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.67
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Humana KY Medicaid |
$5.67
|
| Rate for Payer: Humana Medicare Advantage |
$5.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
OS RHEUMATOID FACTOR IGM
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem Medicaid |
$5.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.67
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Humana KY Medicaid |
$5.67
|
| Rate for Payer: Humana Medicare Advantage |
$5.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
OS RHEUMATOID FACTOR IGM
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.91
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
OS RIBOFLAVIN VITAMIN B2 P
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
30000507
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem Medicaid |
$20.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.24
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Humana KY Medicaid |
$20.24
|
| Rate for Payer: Humana Medicare Advantage |
$20.24
|
| Rate for Payer: Kentucky WC Medicaid |
$20.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.39
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
OS RIBOFLAVIN VITAMIN B2 P
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
30000507
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.01
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.39
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
OS RIBOSOME P AB IGG S
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000416
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
