|
OS SARDINE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000855
|
|
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 SARDINE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000855
|
|
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 SARS COV 2 COVID 19 AMP PRB
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
30001783
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem Medicaid |
$51.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.31
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Humana KY Medicaid |
$51.31
|
| Rate for Payer: Humana Medicare Advantage |
$51.31
|
| Rate for Payer: Kentucky WC Medicaid |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.16
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
OS SARS COV 2 COVID 19 AMP PRB
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
30001783
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$136.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Multiplan PHCS |
$81.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.20
|
| Rate for Payer: UHCCP Medicaid |
$47.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.79
|
|
|
OS SARS COV 2 COVID 19 AMP PRB
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
30001783
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.21
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.16
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
OS SARS-COV2 COVID-19 ANTIBODY
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
30001788
|
|
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 SARS-COV2 COVID-19 ANTIBODY
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
30001788
|
|
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 |
$42.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$58.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.13
|
| 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 |
$42.13
|
| Rate for Payer: Humana Medicare Advantage |
$42.13
|
| Rate for Payer: Kentucky WC Medicaid |
$42.55
|
| 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 |
$50.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.97
|
| 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 SARS-COV2 COVID-19 ANTIBODY
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
30001788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$108.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Multiplan PHCS |
$64.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.60
|
| Rate for Payer: UHCCP Medicaid |
$37.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.28
|
|
|
OS SCALE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000800
|
|
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 SCALE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000800
|
|
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 SCANNABINOL NAT
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| 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 |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.45
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS SCANNABINOL NAT
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.58
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.45
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS SCL 70 AUTOANTIBODY
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
30001004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$185.28 |
| Rate for Payer: Aetna Commercial |
$148.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$160.19
|
| Rate for Payer: First Health Commercial |
$183.35
|
| Rate for Payer: Humana Commercial |
$164.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$158.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$142.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$169.84
|
| Rate for Payer: Ohio Health Group HMO |
$144.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.83
|
| Rate for Payer: PHCS Commercial |
$185.28
|
| Rate for Payer: United Healthcare All Payer |
$169.84
|
|
|
OS SCL 70 AUTOANTIBODY
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
30001004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$185.28 |
| Rate for Payer: Aetna Commercial |
$148.61
|
| Rate for Payer: Anthem Medicaid |
$17.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$160.19
|
| Rate for Payer: First Health Commercial |
$183.35
|
| Rate for Payer: Humana Commercial |
$164.05
|
| Rate for Payer: Humana KY Medicaid |
$17.93
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Kentucky WC Medicaid |
$18.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$158.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$142.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$169.84
|
| Rate for Payer: Ohio Health Group HMO |
$144.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.83
|
| Rate for Payer: PHCS Commercial |
$185.28
|
| Rate for Payer: United Healthcare All Payer |
$169.84
|
|
|
OS SEDATIVE HYPNOTICS URINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS SEDATIVE HYPNOTICS URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| 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 |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS SEDATIVE HYPNOTICS URINE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80368
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$26.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Multiplan PHCS |
$15.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.20
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
|
|
OS SELENIUM S
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 84255
|
| Hospital Charge Code |
30000508
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$25.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.53
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$25.53
|
| Rate for Payer: Humana Medicare Advantage |
$25.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
OS SELENIUM S
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 84255
|
| Hospital Charge Code |
30000508
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.51 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
OS SEROQUEL
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$95.48
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$102.92
|
| Rate for Payer: First Health Commercial |
$117.80
|
| Rate for Payer: Humana Commercial |
$105.40
|
| 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 |
$101.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.12
|
| Rate for Payer: Ohio Health Group HMO |
$93.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.44
|
| Rate for Payer: PHCS Commercial |
$119.04
|
| Rate for Payer: United Healthcare All Payer |
$109.12
|
|
|
OS SEROQUEL
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$119.04 |
| Rate for Payer: Aetna Commercial |
$95.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.57
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$102.92
|
| Rate for Payer: First Health Commercial |
$117.80
|
| Rate for Payer: Humana Commercial |
$105.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$101.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.12
|
| Rate for Payer: Ohio Health Group HMO |
$93.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.44
|
| Rate for Payer: PHCS Commercial |
$119.04
|
| Rate for Payer: United Healthcare All Payer |
$109.12
|
|
|
OS SEROTONIN
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
30000509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$30.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$30.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$43.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.98
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$30.98
|
| Rate for Payer: Humana Medicare Advantage |
$30.98
|
| Rate for Payer: Kentucky WC Medicaid |
$31.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
OS SEROTONIN
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
30000509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
OS SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
30000973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$469.44 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Anthem Medicaid |
$18.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.37
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$405.87
|
| Rate for Payer: First Health Commercial |
$464.55
|
| Rate for Payer: Humana Commercial |
$415.65
|
| Rate for Payer: Humana KY Medicaid |
$18.37
|
| Rate for Payer: Humana Medicare Advantage |
$18.37
|
| Rate for Payer: Kentucky WC Medicaid |
$18.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.32
|
| Rate for Payer: Ohio Health Group HMO |
$366.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.59
|
| Rate for Payer: PHCS Commercial |
$469.44
|
| Rate for Payer: United Healthcare All Payer |
$430.32
|
|
|
OS SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
30000973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.57 |
| Max. Negotiated Rate |
$469.44 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.67
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$405.87
|
| Rate for Payer: First Health Commercial |
$464.55
|
| Rate for Payer: Humana Commercial |
$415.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.32
|
| Rate for Payer: Ohio Health Group HMO |
$366.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.59
|
| Rate for Payer: PHCS Commercial |
$469.44
|
| Rate for Payer: United Healthcare All Payer |
$430.32
|
|
