|
OS URINE CORTISOL 24HR
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
30000287
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$222.72 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$186.30
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna Commercial |
$192.56
|
| Rate for Payer: First Health Commercial |
$220.40
|
| Rate for Payer: Humana Commercial |
$197.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$190.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$204.16
|
| Rate for Payer: Ohio Health Group HMO |
$174.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.92
|
| Rate for Payer: PHCS Commercial |
$222.72
|
| Rate for Payer: United Healthcare All Payer |
$204.16
|
|
|
OS URINE PHOSPHORUS (24HR)
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
30000476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.70
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
OS URINE PHOSPHORUS (24HR)
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
30000476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$5.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.78
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Humana KY Medicaid |
$5.78
|
| Rate for Payer: Humana Medicare Advantage |
$5.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.70
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
OS URINE SEROTONIN (5HIAA)
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 83497
|
| Hospital Charge Code |
30000371
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS URINE SEROTONIN (5HIAA)
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 83497
|
| Hospital Charge Code |
30000371
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$12.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.90
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Humana KY Medicaid |
$12.90
|
| Rate for Payer: Humana Medicare Advantage |
$12.90
|
| Rate for Payer: Kentucky WC Medicaid |
$13.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS VALPROIC ACID FREE
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 80165
|
| Hospital Charge Code |
30000028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$13.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.54
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$13.54
|
| Rate for Payer: Humana Medicare Advantage |
$13.54
|
| Rate for Payer: Kentucky WC Medicaid |
$13.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
OS VALPROIC ACID FREE
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 80165
|
| Hospital Charge Code |
30000028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
OS VALPROIC ACID TOTAL
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
30000027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$13.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.54
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$13.54
|
| Rate for Payer: Humana Medicare Advantage |
$13.54
|
| Rate for Payer: Kentucky WC Medicaid |
$13.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
OS VALPROIC ACID TOTAL
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
30000027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
OS VARICELL ZOSTER VIR BY PCR
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001397
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$310.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.61
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cigna Commercial |
$334.49
|
| Rate for Payer: First Health Commercial |
$382.85
|
| Rate for Payer: Humana Commercial |
$342.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$330.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$297.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$354.64
|
| Rate for Payer: Ohio Health Group HMO |
$302.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.93
|
| Rate for Payer: PHCS Commercial |
$386.88
|
| Rate for Payer: United Healthcare All Payer |
$354.64
|
|
|
OS VARICELL ZOSTER VIR BY PCR
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001397
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$310.31
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cigna Commercial |
$334.49
|
| Rate for Payer: First Health Commercial |
$382.85
|
| Rate for Payer: Humana Commercial |
$342.55
|
| 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 |
$330.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$297.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$354.64
|
| Rate for Payer: Ohio Health Group HMO |
$302.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.93
|
| Rate for Payer: PHCS Commercial |
$386.88
|
| Rate for Payer: United Healthcare All Payer |
$354.64
|
|
|
OS VASOACTI INTESTINA POLYPEP
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
30000554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.21
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
OS VASOACTI INTESTINA POLYPEP
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
30000554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem Medicaid |
$35.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.33
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Humana KY Medicaid |
$35.33
|
| Rate for Payer: Humana Medicare Advantage |
$35.33
|
| Rate for Payer: Kentucky WC Medicaid |
$35.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.21
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
OS VCA IGG
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.26
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
OS VCA IGG
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$14.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$16.06
|
| Rate for Payer: Healthspan PPO |
$14.41
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.88
|
|
|
OS VCA IGG
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$18.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.14
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$18.14
|
| Rate for Payer: Humana Medicare Advantage |
$18.14
|
| Rate for Payer: Kentucky WC Medicaid |
$18.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
OS VCA IGM
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$18.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.14
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$18.14
|
| Rate for Payer: Humana Medicare Advantage |
$18.14
|
| Rate for Payer: Kentucky WC Medicaid |
$18.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
OS VCA IGM
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.26
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
OS VCA IGM
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$14.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$16.06
|
| Rate for Payer: Healthspan PPO |
$14.41
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.88
|
|
|
OS VCAM
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000272
|
|
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 VCAM
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000272
|
|
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 VDRL CSF
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.66
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.28
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
OS VDRL CSF
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.28
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
OS VEGF
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000276
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$14.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.12
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| 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 |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.64
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
OS VEGF
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000276
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.64
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
