|
OS RIBOSOME P AB IGG S
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000416
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$82.50
|
| 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: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| 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 |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| 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
|
|
|
OS RICE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000848
|
|
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 RICE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000848
|
|
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 RISTOCETIN COFACTOR PLASMA
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
30000580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem Medicaid |
$22.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.94
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Humana KY Medicaid |
$22.94
|
| Rate for Payer: Humana Medicare Advantage |
$22.94
|
| Rate for Payer: Kentucky WC Medicaid |
$23.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.75
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
OS RISTOCETIN COFACTOR PLASMA
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
30000580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.68
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.75
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
OS ROCKY MTN SPOT FEVER AB IGG
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
30001207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem Medicaid |
$19.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.35
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Humana KY Medicaid |
$19.35
|
| Rate for Payer: Humana Medicare Advantage |
$19.35
|
| Rate for Payer: Kentucky WC Medicaid |
$19.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
OS ROCKY MTN SPOT FEVER AB IGG
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
30001207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
OS ROCKY MT SP FEVER IGM
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
30001208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
OS ROCKY MT SP FEVER IGM
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
30001208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem Medicaid |
$19.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.35
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Humana KY Medicaid |
$19.35
|
| Rate for Payer: Humana Medicare Advantage |
$19.35
|
| Rate for Payer: Kentucky WC Medicaid |
$19.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
OS ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000647
|
|
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 ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000647
|
|
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 RUBELLA AB IGG
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
30001209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.45
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
OS RUBELLA AB IGG
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
30001209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$14.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$14.39
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Kentucky WC Medicaid |
$14.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
OS RUBEOLA MEASLES AB
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
30001211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$161.28 |
| Rate for Payer: Aetna Commercial |
$129.36
|
| Rate for Payer: Anthem Medicaid |
$12.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$139.44
|
| Rate for Payer: First Health Commercial |
$159.60
|
| Rate for Payer: Humana Commercial |
$142.80
|
| Rate for Payer: Humana KY Medicaid |
$12.88
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Kentucky WC Medicaid |
$13.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.84
|
| Rate for Payer: Ohio Health Group HMO |
$126.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.08
|
| Rate for Payer: PHCS Commercial |
$161.28
|
| Rate for Payer: United Healthcare All Payer |
$147.84
|
|
|
OS RUBEOLA MEASLES AB
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
30001211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$161.28 |
| Rate for Payer: Aetna Commercial |
$129.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.90
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$139.44
|
| Rate for Payer: First Health Commercial |
$159.60
|
| Rate for Payer: Humana Commercial |
$142.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.84
|
| Rate for Payer: Ohio Health Group HMO |
$126.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.08
|
| Rate for Payer: PHCS Commercial |
$161.28
|
| Rate for Payer: United Healthcare All Payer |
$147.84
|
|
|
OS RUSSIAN THISTLE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000820
|
|
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 RUSSIAN THISTLE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000820
|
|
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 SAA
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000273
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.88
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS SAA
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000273
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$14.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.12
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Humana KY Medicaid |
$14.12
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$14.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.88
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS SACCHAROM CEREVISIAE IGG S
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
30001159
|
|
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
|
|
|
OS SACCHAROM CEREVISIAE IGG S
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
30001159
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$12.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.25
|
| Rate for Payer: Cash Price |
$82.50
|
| 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: Humana KY Medicaid |
$12.25
|
| Rate for Payer: Humana Medicare Advantage |
$12.25
|
| Rate for Payer: Kentucky WC Medicaid |
$12.37
|
| 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 |
$14.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.50
|
| 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
|
|
|
OS SACCHAROMY CEREVISIAE IGA S
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
30001160
|
|
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
|
|
|
OS SACCHAROMY CEREVISIAE IGA S
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
30001160
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$12.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.25
|
| Rate for Payer: Cash Price |
$82.50
|
| 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: Humana KY Medicaid |
$12.25
|
| Rate for Payer: Humana Medicare Advantage |
$12.25
|
| Rate for Payer: Kentucky WC Medicaid |
$12.37
|
| 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 |
$14.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.50
|
| 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
|
|
|
OS SALICYLATE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 80179
|
| Hospital Charge Code |
30001559
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem Medicaid |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Humana KY Medicaid |
$18.64
|
| Rate for Payer: Humana Medicare Advantage |
$18.64
|
| Rate for Payer: Kentucky WC Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
OS SALICYLATE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 80179
|
| Hospital Charge Code |
30001559
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
