|
OS IntelliGEN Myeloid
|
Facility
|
IP
|
$4,722.00
|
|
|
Service Code
|
HCPCS 81450
|
| Hospital Charge Code |
30001898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,416.60 |
| Max. Negotiated Rate |
$4,533.12 |
| Rate for Payer: Aetna Commercial |
$3,635.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,791.77
|
| 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: 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 |
$1,416.60
|
| 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
|
|
|
OS INTERLEUKIN 1B
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000402
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.10 |
| Max. Negotiated Rate |
$457.92 |
| Rate for Payer: Aetna Commercial |
$367.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$383.03
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$395.91
|
| Rate for Payer: First Health Commercial |
$453.15
|
| Rate for Payer: Humana Commercial |
$405.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$419.76
|
| Rate for Payer: Ohio Health Group HMO |
$357.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$414.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.13
|
| Rate for Payer: PHCS Commercial |
$457.92
|
| Rate for Payer: United Healthcare All Payer |
$419.76
|
|
|
OS INTERLEUKIN 1B
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000402
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$457.92 |
| Rate for Payer: Aetna Commercial |
$367.29
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$383.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$395.91
|
| Rate for Payer: First Health Commercial |
$453.15
|
| Rate for Payer: Humana Commercial |
$405.45
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$419.76
|
| Rate for Payer: Ohio Health Group HMO |
$357.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$414.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.13
|
| Rate for Payer: PHCS Commercial |
$457.92
|
| Rate for Payer: United Healthcare All Payer |
$419.76
|
|
|
OS INTERLEUKIN 6
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 83529
|
| Hospital Charge Code |
30000420
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.54
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS INTERLEUKIN 6
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 83529
|
| Hospital Charge Code |
30000420
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.54
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS INTERPHAS INSIT HYBRDZAT 1
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$51.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.19
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$51.19
|
| Rate for Payer: Humana Medicare Advantage |
$51.19
|
| Rate for Payer: Kentucky WC Medicaid |
$51.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS INSIT HYBRDZAT 1
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS INSIT HYBRDZAT 2
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$51.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.19
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$51.19
|
| Rate for Payer: Humana Medicare Advantage |
$51.19
|
| Rate for Payer: Kentucky WC Medicaid |
$51.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS INSIT HYBRDZAT 2
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001499
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$51.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.19
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$51.19
|
| Rate for Payer: Humana Medicare Advantage |
$51.19
|
| Rate for Payer: Kentucky WC Medicaid |
$51.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS INSIT HYBRDZAT 2
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS INSIT HYBRDZAT 2
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001499
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS IN SITU HYBRID 1
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.53
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
OS INTERPHAS IN SITU HYBRID 1
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$51.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.19
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$51.19
|
| Rate for Payer: Humana Medicare Advantage |
$51.19
|
| Rate for Payer: Kentucky WC Medicaid |
$51.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
OS INTERPHAS IN SITU HYBRID 3
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$51.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.19
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$51.19
|
| Rate for Payer: Humana Medicare Advantage |
$51.19
|
| Rate for Payer: Kentucky WC Medicaid |
$51.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS IN SITU HYBRID 3
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS IN SITU HYBRID 4
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$51.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.19
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$51.19
|
| Rate for Payer: Humana Medicare Advantage |
$51.19
|
| Rate for Payer: Kentucky WC Medicaid |
$51.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS IN SITU HYBRID 4
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS IN SITU HYBRID 5
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$51.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.19
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$51.19
|
| Rate for Payer: Humana Medicare Advantage |
$51.19
|
| Rate for Payer: Kentucky WC Medicaid |
$51.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS IN SITU HYBRID 5
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS IN SITU HYBRID 6
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS IN SITU HYBRID 6
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$51.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.19
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$51.19
|
| Rate for Payer: Humana Medicare Advantage |
$51.19
|
| Rate for Payer: Kentucky WC Medicaid |
$51.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS INTERPHAS SITU HYBRIDZATI
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS 88274
|
| Hospital Charge Code |
30001490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.60 |
| Max. Negotiated Rate |
$289.92 |
| Rate for Payer: Aetna Commercial |
$232.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$242.51
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cigna Commercial |
$250.66
|
| Rate for Payer: First Health Commercial |
$286.90
|
| Rate for Payer: Humana Commercial |
$256.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$247.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$265.76
|
| Rate for Payer: Ohio Health Group HMO |
$226.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.38
|
| Rate for Payer: PHCS Commercial |
$289.92
|
| Rate for Payer: United Healthcare All Payer |
$265.76
|
|
|
OS INTERPHAS SITU HYBRIDZATI
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS 88274
|
| Hospital Charge Code |
30001490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$289.92 |
| Rate for Payer: Aetna Commercial |
$232.54
|
| Rate for Payer: Anthem Medicaid |
$42.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$242.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.38
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cigna Commercial |
$250.66
|
| Rate for Payer: First Health Commercial |
$286.90
|
| Rate for Payer: Humana Commercial |
$256.70
|
| Rate for Payer: Humana KY Medicaid |
$42.38
|
| Rate for Payer: Humana Medicare Advantage |
$42.38
|
| Rate for Payer: Kentucky WC Medicaid |
$42.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$247.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$265.76
|
| Rate for Payer: Ohio Health Group HMO |
$226.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.38
|
| Rate for Payer: PHCS Commercial |
$289.92
|
| Rate for Payer: United Healthcare All Payer |
$265.76
|
|
|
OS INTRINSIC FACTOR BL. AB
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 86340
|
| Hospital Charge Code |
30001072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.95
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
OS INTRINSIC FACTOR BL. AB
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 86340
|
| Hospital Charge Code |
30001072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem Medicaid |
$15.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.08
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Humana KY Medicaid |
$15.08
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$15.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
