|
OS ECHINOCOCCOSIS AB SERUM
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
30001202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem Medicaid |
$12.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.39
|
| 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 |
$12.39
|
| Rate for Payer: Humana Medicare Advantage |
$12.39
|
| Rate for Payer: Kentucky WC Medicaid |
$12.51
|
| 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 |
$14.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.64
|
| 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 |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.84
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
OS ECM1 SNP
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: Aetna Commercial |
$142.45
|
| Rate for Payer: Anthem Medicaid |
$63.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.56
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: First Health Commercial |
$175.75
|
| Rate for Payer: Humana Commercial |
$157.25
|
| Rate for Payer: Humana KY Medicaid |
$63.62
|
| Rate for Payer: Kentucky WC Medicaid |
$64.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.80
|
| Rate for Payer: Ohio Health Group HMO |
$138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.65
|
| Rate for Payer: PHCS Commercial |
$177.60
|
| Rate for Payer: United Healthcare All Payer |
$162.80
|
|
|
OS ECM1 SNP
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: Aetna Commercial |
$142.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.56
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: First Health Commercial |
$175.75
|
| Rate for Payer: Humana Commercial |
$157.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.80
|
| Rate for Payer: Ohio Health Group HMO |
$138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.65
|
| Rate for Payer: PHCS Commercial |
$177.60
|
| Rate for Payer: United Healthcare All Payer |
$162.80
|
|
|
OS EGGPLANT IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS EGGPLANT IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS EGG YOLK IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000693
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS EGG YOLK IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000693
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS E HISTOLYTICA AB S
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
30001200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
OS E HISTOLYTICA AB S
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
30001200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem Medicaid |
$12.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.39
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Humana KY Medicaid |
$12.39
|
| Rate for Payer: Humana Medicare Advantage |
$12.39
|
| Rate for Payer: Kentucky WC Medicaid |
$12.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
OS EHRILCHIA CHAFFENIS AB IGG
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
30001158
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$378.24 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: Anthem Medicaid |
$10.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$316.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.18
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$327.02
|
| Rate for Payer: First Health Commercial |
$374.30
|
| Rate for Payer: Humana Commercial |
$334.90
|
| Rate for Payer: Humana KY Medicaid |
$10.18
|
| Rate for Payer: Humana Medicare Advantage |
$10.18
|
| Rate for Payer: Kentucky WC Medicaid |
$10.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
| Rate for Payer: Ohio Health Group HMO |
$295.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$342.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.86
|
| Rate for Payer: PHCS Commercial |
$378.24
|
| Rate for Payer: United Healthcare All Payer |
$346.72
|
|
|
OS EHRILCHIA CHAFFENIS AB IGG
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
30001158
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$378.24 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$316.38
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$327.02
|
| Rate for Payer: First Health Commercial |
$374.30
|
| Rate for Payer: Humana Commercial |
$334.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
| Rate for Payer: Ohio Health Group HMO |
$295.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$342.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.86
|
| Rate for Payer: PHCS Commercial |
$378.24
|
| Rate for Payer: United Healthcare All Payer |
$346.72
|
|
|
OS EHRLICHIA CHAFFEENSIS
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 87484
|
| Hospital Charge Code |
30001793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$49.13 |
| Rate for Payer: Aetna Commercial |
$30.03
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.37
|
| Rate for Payer: First Health Commercial |
$37.05
|
| Rate for Payer: Humana Commercial |
$33.15
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.32
|
| Rate for Payer: Ohio Health Group HMO |
$29.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.91
|
| Rate for Payer: PHCS Commercial |
$37.44
|
| Rate for Payer: United Healthcare All Payer |
$34.32
|
|
|
OS EHRLICHIA CHAFFEENSIS
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 87484
|
| Hospital Charge Code |
30001793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$37.44 |
| Rate for Payer: Aetna Commercial |
$30.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.32
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.37
|
| Rate for Payer: First Health Commercial |
$37.05
|
| Rate for Payer: Humana Commercial |
$33.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.32
|
| Rate for Payer: Ohio Health Group HMO |
$29.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.91
|
| Rate for Payer: PHCS Commercial |
$37.44
|
| Rate for Payer: United Healthcare All Payer |
$34.32
|
|
|
OS EHRLICHIA EWINGII/CANIS
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$49.13 |
| Rate for Payer: Aetna Commercial |
$29.26
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$31.54
|
| Rate for Payer: First Health Commercial |
$36.10
|
| Rate for Payer: Humana Commercial |
$32.30
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.44
|
| Rate for Payer: Ohio Health Group HMO |
$28.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.22
|
| Rate for Payer: PHCS Commercial |
$36.48
|
| Rate for Payer: United Healthcare All Payer |
$33.44
|
|
|
OS EHRLICHIA EWINGII/CANIS
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$22.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$13.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
OS EHRLICHIA EWINGII/CANIS
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$36.48 |
| Rate for Payer: Aetna Commercial |
$29.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.51
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$31.54
|
| Rate for Payer: First Health Commercial |
$36.10
|
| Rate for Payer: Humana Commercial |
$32.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.44
|
| Rate for Payer: Ohio Health Group HMO |
$28.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.22
|
| Rate for Payer: PHCS Commercial |
$36.48
|
| Rate for Payer: United Healthcare All Payer |
$33.44
|
|
|
OS EHRLICHIA MURIS EAUCLRENSIS
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001795
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$49.13 |
| Rate for Payer: Aetna Commercial |
$29.26
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$31.54
|
| Rate for Payer: First Health Commercial |
$36.10
|
| Rate for Payer: Humana Commercial |
$32.30
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.44
|
| Rate for Payer: Ohio Health Group HMO |
$28.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.22
|
| Rate for Payer: PHCS Commercial |
$36.48
|
| Rate for Payer: United Healthcare All Payer |
$33.44
|
|
|
OS EHRLICHIA MURIS EAUCLRENSIS
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001795
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$36.48 |
| Rate for Payer: Aetna Commercial |
$29.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.51
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$31.54
|
| Rate for Payer: First Health Commercial |
$36.10
|
| Rate for Payer: Humana Commercial |
$32.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.44
|
| Rate for Payer: Ohio Health Group HMO |
$28.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.22
|
| Rate for Payer: PHCS Commercial |
$36.48
|
| Rate for Payer: United Healthcare All Payer |
$33.44
|
|
|
OS EHRLICHIA MURIS EAUCLRENSIS
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001795
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$22.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$13.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
OS EL-1 FECAL QUANTITATIVE
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 82653
|
| Hospital Charge Code |
30001995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem Medicaid |
$22.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.97
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Humana KY Medicaid |
$22.97
|
| Rate for Payer: Humana Medicare Advantage |
$22.97
|
| Rate for Payer: Kentucky WC Medicaid |
$23.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.74
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
OS EL-1 FECAL QUANTITATIVE
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 82653
|
| Hospital Charge Code |
30001995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.74
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
OS ELDER IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000763
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS ELDER IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000763
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS ELECTRON MICROSCOPY
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 88348
|
| Hospital Charge Code |
30001975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$1,056.72 |
| Rate for Payer: Aetna Commercial |
$350.35
|
| Rate for Payer: Anthem Medicaid |
$754.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$754.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,056.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$754.80
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$377.65
|
| Rate for Payer: First Health Commercial |
$432.25
|
| Rate for Payer: Humana Commercial |
$386.75
|
| Rate for Payer: Humana KY Medicaid |
$754.80
|
| Rate for Payer: Humana Medicare Advantage |
$754.80
|
| Rate for Payer: Kentucky WC Medicaid |
$762.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$905.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$769.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$400.40
|
| Rate for Payer: Ohio Health Group HMO |
$341.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.95
|
| Rate for Payer: PHCS Commercial |
$436.80
|
| Rate for Payer: United Healthcare All Payer |
$400.40
|
|
|
OS ELECTRON MICROSCOPY
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 88348
|
| Hospital Charge Code |
30001975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$436.80 |
| Rate for Payer: Aetna Commercial |
$350.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.37
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$377.65
|
| Rate for Payer: First Health Commercial |
$432.25
|
| Rate for Payer: Humana Commercial |
$386.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$400.40
|
| Rate for Payer: Ohio Health Group HMO |
$341.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.95
|
| Rate for Payer: PHCS Commercial |
$436.80
|
| Rate for Payer: United Healthcare All Payer |
$400.40
|
|
