|
OS IMIPRAMINE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
OS IMMUNE COMPLEX ASSAY
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 86332
|
| Hospital Charge Code |
30002058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
OS IMMUNE COMPLEX ASSAY
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 86332
|
| Hospital Charge Code |
30002058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$24.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.37
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$24.37
|
| Rate for Payer: Humana Medicare Advantage |
$24.37
|
| Rate for Payer: Kentucky WC Medicaid |
$24.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
OS IMMUNODIFFUSION OUCHTERLONY
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 86331
|
| Hospital Charge Code |
30001998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem Medicaid |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Humana KY Medicaid |
$11.98
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Kentucky WC Medicaid |
$12.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
OS IMMUNODIFFUSION OUCHTERLONY
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 86331
|
| Hospital Charge Code |
30001998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.07
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
OS IMMUNOELECTROPHORESISSERUM
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 86320
|
| Hospital Charge Code |
30001066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OS IMMUNOELECTROPHORESISSERUM
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 86320
|
| Hospital Charge Code |
30001066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.92 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$29.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.92
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Humana KY Medicaid |
$29.92
|
| Rate for Payer: Humana Medicare Advantage |
$29.92
|
| Rate for Payer: Kentucky WC Medicaid |
$30.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OS IMMUNOELECTROPHORESIS URINE
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 86325
|
| Hospital Charge Code |
30001067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.80 |
| 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 |
$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 IMMUNOELECTROPHORESIS URINE
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 86325
|
| Hospital Charge Code |
30001067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem Medicaid |
$23.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.13
|
| 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 |
$23.13
|
| Rate for Payer: Humana Medicare Advantage |
$23.13
|
| Rate for Payer: Kentucky WC Medicaid |
$23.36
|
| 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 |
$27.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.59
|
| 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 IMMUNOFIXATION CSF/URINE
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
30001069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
OS IMMUNOFIXATION CSF/URINE
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
30001069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem Medicaid |
$29.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.35
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Humana KY Medicaid |
$29.35
|
| Rate for Payer: Humana Medicare Advantage |
$29.35
|
| Rate for Payer: Kentucky WC Medicaid |
$29.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
OS IMMUNOFIXATION SERUM
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
30001068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$350.40 |
| Rate for Payer: Aetna Commercial |
$281.05
|
| Rate for Payer: Anthem Medicaid |
$22.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$293.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.34
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$302.95
|
| Rate for Payer: First Health Commercial |
$346.75
|
| Rate for Payer: Humana Commercial |
$310.25
|
| Rate for Payer: Humana KY Medicaid |
$22.34
|
| Rate for Payer: Humana Medicare Advantage |
$22.34
|
| Rate for Payer: Kentucky WC Medicaid |
$22.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$299.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$269.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$321.20
|
| Rate for Payer: Ohio Health Group HMO |
$273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.85
|
| Rate for Payer: PHCS Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Payer |
$321.20
|
|
|
OS IMMUNOFIXATION SERUM
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
30001068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$350.40 |
| Rate for Payer: Aetna Commercial |
$281.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$293.10
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$302.95
|
| Rate for Payer: First Health Commercial |
$346.75
|
| Rate for Payer: Humana Commercial |
$310.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$299.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$269.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$321.20
|
| Rate for Payer: Ohio Health Group HMO |
$273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.85
|
| Rate for Payer: PHCS Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Payer |
$321.20
|
|
|
OS IMMUNOFLUOR ANTB ADDL STAIN
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 88350
|
| Hospital Charge Code |
30001837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| 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 |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
OS IMMUNOFLUOR ANTB ADDL STAIN
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 88350
|
| Hospital Charge Code |
30001837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$15.13
|
| 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: Humana KY Medicaid |
$15.13
|
| Rate for Payer: Kentucky WC Medicaid |
$15.29
|
| 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: Molina Healthcare Medicaid |
$15.44
|
| 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 |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
OS IMMUNOGLOBULIN E (IGE)
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
30000325
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13.65
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cigna Commercial |
$14.11
|
| Rate for Payer: First Health Commercial |
$16.15
|
| Rate for Payer: Humana Commercial |
$14.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.96
|
| Rate for Payer: Ohio Health Group HMO |
$12.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.73
|
| Rate for Payer: PHCS Commercial |
$16.32
|
| Rate for Payer: United Healthcare All Payer |
$14.96
|
|
|
OS IMMUNOGLOBULIN E (IGE)
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
30000325
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$23.04 |
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Anthem Medicaid |
$16.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.46
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cigna Commercial |
$14.11
|
| Rate for Payer: First Health Commercial |
$16.15
|
| Rate for Payer: Humana Commercial |
$14.45
|
| Rate for Payer: Humana KY Medicaid |
$16.46
|
| Rate for Payer: Humana Medicare Advantage |
$16.46
|
| Rate for Payer: Kentucky WC Medicaid |
$16.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.96
|
| Rate for Payer: Ohio Health Group HMO |
$12.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.73
|
| Rate for Payer: PHCS Commercial |
$16.32
|
| Rate for Payer: United Healthcare All Payer |
$14.96
|
|
|
OS IMMUNOHISTOCHEM 1ST
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
30001526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$358.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Humana KY Medicaid |
$158.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.33
|
| Rate for Payer: Kentucky WC Medicaid |
$159.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
OS IMMUNOHISTOCHEM 1ST
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
30001526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$358.14
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
OS IMMUNOHISTOCHEM EA ANTIB
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
HCPCS 88361
|
| Hospital Charge Code |
30001533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$177.90 |
| Max. Negotiated Rate |
$569.28 |
| Rate for Payer: Aetna Commercial |
$456.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.18
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Cigna Commercial |
$492.19
|
| Rate for Payer: First Health Commercial |
$563.35
|
| Rate for Payer: Humana Commercial |
$504.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$486.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$437.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$521.84
|
| Rate for Payer: Ohio Health Group HMO |
$444.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.17
|
| Rate for Payer: PHCS Commercial |
$569.28
|
| Rate for Payer: United Healthcare All Payer |
$521.84
|
|
|
OS IMMUNOHISTOCHEM EA ANTIB
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
HCPCS 88361
|
| Hospital Charge Code |
30001533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$332.37 |
| Max. Negotiated Rate |
$569.28 |
| Rate for Payer: Aetna Commercial |
$456.61
|
| Rate for Payer: Anthem Medicaid |
$332.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$332.37
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Cigna Commercial |
$492.19
|
| Rate for Payer: First Health Commercial |
$563.35
|
| Rate for Payer: Humana Commercial |
$504.05
|
| Rate for Payer: Humana KY Medicaid |
$332.37
|
| Rate for Payer: Humana Medicare Advantage |
$332.37
|
| Rate for Payer: Kentucky WC Medicaid |
$335.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$486.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$437.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$521.84
|
| Rate for Payer: Ohio Health Group HMO |
$444.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.17
|
| Rate for Payer: PHCS Commercial |
$569.28
|
| Rate for Payer: United Healthcare All Payer |
$521.84
|
|
|
OS IMMUNOSTAIN EACH ADDITIONAL
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
30001523
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$358.14
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
OS IMMUNOSTAIN EACH ADDITIONAL
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
30001523
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem Medicaid |
$153.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$358.14
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Humana KY Medicaid |
$153.38
|
| Rate for Payer: Kentucky WC Medicaid |
$154.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
OS INFLIXIMAB
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 80230
|
| Hospital Charge Code |
30001853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem Medicaid |
$38.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.57
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Humana KY Medicaid |
$38.57
|
| Rate for Payer: Humana Medicare Advantage |
$38.57
|
| Rate for Payer: Kentucky WC Medicaid |
$38.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$295.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.60
|
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
|
OS INFLIXIMAB
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 80230
|
| Hospital Charge Code |
30001853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.02
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$295.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.60
|
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
