|
OS INFLUENZA VIR A AB IGG
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIR A AB IGG
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$13.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$13.55
|
| Rate for Payer: Humana Medicare Advantage |
$13.55
|
| Rate for Payer: Kentucky WC Medicaid |
$13.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIR B AB IGG
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001188
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIR B AB IGG
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001188
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$13.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$13.55
|
| Rate for Payer: Humana Medicare Advantage |
$13.55
|
| Rate for Payer: Kentucky WC Medicaid |
$13.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIRU A ANTIB IGM
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIRU A ANTIB IGM
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$13.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$13.55
|
| Rate for Payer: Humana Medicare Advantage |
$13.55
|
| Rate for Payer: Kentucky WC Medicaid |
$13.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIRU B ANTIB IGM
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001189
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$13.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$13.55
|
| Rate for Payer: Humana Medicare Advantage |
$13.55
|
| Rate for Payer: Kentucky WC Medicaid |
$13.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIRU B ANTIB IGM
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001189
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INHIBIN
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
30001070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$253.44 |
| Rate for Payer: Aetna Commercial |
$203.28
|
| Rate for Payer: Anthem Medicaid |
$15.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$211.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.59
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$219.12
|
| Rate for Payer: First Health Commercial |
$250.80
|
| Rate for Payer: Humana Commercial |
$224.40
|
| Rate for Payer: Humana KY Medicaid |
$15.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.59
|
| Rate for Payer: Kentucky WC Medicaid |
$15.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$216.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$232.32
|
| Rate for Payer: Ohio Health Group HMO |
$198.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$211.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.16
|
| Rate for Payer: PHCS Commercial |
$253.44
|
| Rate for Payer: United Healthcare All Payer |
$232.32
|
|
|
OS INHIBIN
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
30001070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$253.44 |
| Rate for Payer: Aetna Commercial |
$203.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$211.99
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$219.12
|
| Rate for Payer: First Health Commercial |
$250.80
|
| Rate for Payer: Humana Commercial |
$224.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$216.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$232.32
|
| Rate for Payer: Ohio Health Group HMO |
$198.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$211.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.16
|
| Rate for Payer: PHCS Commercial |
$253.44
|
| Rate for Payer: United Healthcare All Payer |
$232.32
|
|
|
OS INSITU HYBRIDIZATION (FISH)
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 88365
|
| Hospital Charge Code |
30001858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| 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 |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
OS INSITU HYBRIDIZATION (FISH)
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 88365
|
| Hospital Charge Code |
30001858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.59
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
OS INSITU HYBRIDIZ (FISH) ADD
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 88364
|
| Hospital Charge Code |
30001879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$497.28 |
| Rate for Payer: Aetna Commercial |
$398.86
|
| Rate for Payer: Anthem Medicaid |
$178.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$415.95
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$429.94
|
| Rate for Payer: First Health Commercial |
$492.10
|
| Rate for Payer: Humana Commercial |
$440.30
|
| Rate for Payer: Humana KY Medicaid |
$178.14
|
| Rate for Payer: Kentucky WC Medicaid |
$179.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$424.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$382.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$181.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$455.84
|
| Rate for Payer: Ohio Health Group HMO |
$388.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$357.42
|
| Rate for Payer: PHCS Commercial |
$497.28
|
| Rate for Payer: United Healthcare All Payer |
$455.84
|
|
|
OS INSITU HYBRIDIZ (FISH) ADD
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 88364
|
| Hospital Charge Code |
30001879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$497.28 |
| Rate for Payer: Aetna Commercial |
$398.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$415.95
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$429.94
|
| Rate for Payer: First Health Commercial |
$492.10
|
| Rate for Payer: Humana Commercial |
$440.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$424.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$382.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$455.84
|
| Rate for Payer: Ohio Health Group HMO |
$388.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$357.42
|
| Rate for Payer: PHCS Commercial |
$497.28
|
| Rate for Payer: United Healthcare All Payer |
$455.84
|
|
|
OS INSULIN ANTIBODIES
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 86337
|
| Hospital Charge Code |
30001071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS INSULIN ANTIBODIES
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 86337
|
| Hospital Charge Code |
30001071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.41
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.41
|
| Rate for Payer: Humana Medicare Advantage |
$21.41
|
| Rate for Payer: Kentucky WC Medicaid |
$21.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS INSULIN BEEF IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000956
|
|
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 INSULIN BEEF IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000956
|
|
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 INSULIN HUMAN IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000891
|
|
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 INSULIN HUMAN IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000891
|
|
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 INSULIN LIKE GROWTH FACT 1
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
HCPCS 84305
|
| Hospital Charge Code |
30000514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Aetna Commercial |
$293.37
|
| Rate for Payer: Anthem Medicaid |
$21.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$305.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.26
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$316.23
|
| Rate for Payer: First Health Commercial |
$361.95
|
| Rate for Payer: Humana Commercial |
$323.85
|
| Rate for Payer: Humana KY Medicaid |
$21.26
|
| Rate for Payer: Humana Medicare Advantage |
$21.26
|
| Rate for Payer: Kentucky WC Medicaid |
$21.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$312.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$335.28
|
| Rate for Payer: Ohio Health Group HMO |
$285.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$331.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.89
|
| Rate for Payer: PHCS Commercial |
$365.76
|
| Rate for Payer: United Healthcare All Payer |
$335.28
|
|
|
OS INSULIN LIKE GROWTH FACT 1
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
HCPCS 84305
|
| Hospital Charge Code |
30000514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.30 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Aetna Commercial |
$293.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$305.94
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$316.23
|
| Rate for Payer: First Health Commercial |
$361.95
|
| Rate for Payer: Humana Commercial |
$323.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$312.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$335.28
|
| Rate for Payer: Ohio Health Group HMO |
$285.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$331.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.89
|
| Rate for Payer: PHCS Commercial |
$365.76
|
| Rate for Payer: United Healthcare All Payer |
$335.28
|
|
|
OS INSULIN PORK IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000792
|
|
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 INSULIN PORK IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000792
|
|
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 IntelliGEN Myeloid
|
Facility
|
OP
|
$4,722.00
|
|
|
Service Code
|
HCPCS 81450
|
| Hospital Charge Code |
30001898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$759.53 |
| Max. Negotiated Rate |
$4,533.12 |
| Rate for Payer: Aetna Commercial |
$3,635.94
|
| Rate for Payer: Anthem Medicaid |
$759.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,791.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,063.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.53
|
| Rate for Payer: Cash Price |
$2,361.00
|
| Rate for Payer: Cash Price |
$2,361.00
|
| Rate for Payer: Cigna Commercial |
$3,919.26
|
| Rate for Payer: First Health Commercial |
$4,485.90
|
| Rate for Payer: Humana Commercial |
$4,013.70
|
| Rate for Payer: Humana KY Medicaid |
$759.53
|
| Rate for Payer: Humana Medicare Advantage |
$759.53
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,872.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,484.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,155.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,541.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,777.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,108.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,258.18
|
| Rate for Payer: PHCS Commercial |
$4,533.12
|
| Rate for Payer: United Healthcare All Payer |
$4,155.36
|
|
