|
OS Iodine/Creat Ratio, U
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
30001866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem Medicaid |
$24.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$220.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.11
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Humana KY Medicaid |
$24.11
|
| Rate for Payer: Humana Medicare Advantage |
$24.11
|
| Rate for Payer: Kentucky WC Medicaid |
$24.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.75
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
OS Iodine/Creat Ratio, U
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
30001866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$220.82
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.75
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
OS ISLET CELL CYTOPLASMAB IGG
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
30001074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$218.68
|
| Rate for Payer: Anthem Medicaid |
$23.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.57
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$235.72
|
| Rate for Payer: First Health Commercial |
$269.80
|
| Rate for Payer: Humana Commercial |
$241.40
|
| Rate for Payer: Humana KY Medicaid |
$23.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.57
|
| Rate for Payer: Kentucky WC Medicaid |
$23.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$209.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.92
|
| Rate for Payer: Ohio Health Group HMO |
$213.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.96
|
| Rate for Payer: PHCS Commercial |
$272.64
|
| Rate for Payer: United Healthcare All Payer |
$249.92
|
|
|
OS ISLET CELL CYTOPLASMAB IGG
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
30001074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$218.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.05
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$235.72
|
| Rate for Payer: First Health Commercial |
$269.80
|
| Rate for Payer: Humana Commercial |
$241.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$209.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.92
|
| Rate for Payer: Ohio Health Group HMO |
$213.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.96
|
| Rate for Payer: PHCS Commercial |
$272.64
|
| Rate for Payer: United Healthcare All Payer |
$249.92
|
|
|
OS ISOCYANATE HDI IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000817
|
|
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 ISOCYANATE HDI IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000817
|
|
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 ISPAGHULA IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000703
|
|
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 ISPAGHULA IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000703
|
|
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 ITRACONAZOLE
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
HCPCS 80189
|
| Hospital Charge Code |
30001882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$545.28 |
| Rate for Payer: Aetna Commercial |
$437.36
|
| Rate for Payer: Anthem Medicaid |
$27.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.11
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cigna Commercial |
$471.44
|
| Rate for Payer: First Health Commercial |
$539.60
|
| Rate for Payer: Humana Commercial |
$482.80
|
| Rate for Payer: Humana KY Medicaid |
$27.11
|
| Rate for Payer: Humana Medicare Advantage |
$27.11
|
| Rate for Payer: Kentucky WC Medicaid |
$27.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$465.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$499.84
|
| Rate for Payer: Ohio Health Group HMO |
$426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.92
|
| Rate for Payer: PHCS Commercial |
$545.28
|
| Rate for Payer: United Healthcare All Payer |
$499.84
|
|
|
OS ITRACONAZOLE
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
HCPCS 80189
|
| Hospital Charge Code |
30001882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$545.28 |
| Rate for Payer: Aetna Commercial |
$437.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.10
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cigna Commercial |
$471.44
|
| Rate for Payer: First Health Commercial |
$539.60
|
| Rate for Payer: Humana Commercial |
$482.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$465.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$499.84
|
| Rate for Payer: Ohio Health Group HMO |
$426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.92
|
| Rate for Payer: PHCS Commercial |
$545.28
|
| Rate for Payer: United Healthcare All Payer |
$499.84
|
|
|
OS JAK2 GENE TRGT SEQ ALYS
|
Facility
|
OP
|
$481.33
|
|
|
Service Code
|
HCPCS 0027U
|
| Hospital Charge Code |
30002010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$121.91 |
| Max. Negotiated Rate |
$462.08 |
| Rate for Payer: Aetna Commercial |
$370.62
|
| Rate for Payer: Anthem Medicaid |
$121.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$121.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$170.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.91
|
| Rate for Payer: Cash Price |
$240.66
|
| Rate for Payer: Cash Price |
$240.66
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: First Health Commercial |
$457.26
|
| Rate for Payer: Humana Commercial |
$409.13
|
| Rate for Payer: Humana KY Medicaid |
$121.91
|
| Rate for Payer: Humana Medicare Advantage |
$121.91
|
| Rate for Payer: Kentucky WC Medicaid |
$123.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.57
|
| Rate for Payer: Ohio Health Group HMO |
$361.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.12
|
| Rate for Payer: PHCS Commercial |
$462.08
|
| Rate for Payer: United Healthcare All Payer |
$423.57
|
|
|
OS JAK2 GENE TRGT SEQ ALYS
|
Facility
|
IP
|
$481.33
|
|
|
Service Code
|
HCPCS 0027U
|
| Hospital Charge Code |
30002010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$144.40 |
| Max. Negotiated Rate |
$462.08 |
| Rate for Payer: Aetna Commercial |
$370.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.51
|
| Rate for Payer: Cash Price |
$240.66
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: First Health Commercial |
$457.26
|
| Rate for Payer: Humana Commercial |
$409.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.57
|
| Rate for Payer: Ohio Health Group HMO |
$361.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.12
|
| Rate for Payer: PHCS Commercial |
$462.08
|
| Rate for Payer: United Healthcare All Payer |
$423.57
|
|
|
OS JAK2 V617F MUTATION DET
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
30000191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.70 |
| Max. Negotiated Rate |
$603.84 |
| Rate for Payer: Aetna Commercial |
$484.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.09
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cigna Commercial |
$522.07
|
| Rate for Payer: First Health Commercial |
$597.55
|
| Rate for Payer: Humana Commercial |
$534.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$515.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$553.52
|
| Rate for Payer: Ohio Health Group HMO |
$471.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.01
|
| Rate for Payer: PHCS Commercial |
$603.84
|
| Rate for Payer: United Healthcare All Payer |
$553.52
|
|
|
OS JAK2 V617F MUTATION DET
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
30000191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.66 |
| Max. Negotiated Rate |
$603.84 |
| Rate for Payer: Aetna Commercial |
$484.33
|
| Rate for Payer: Anthem Medicaid |
$91.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$91.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$128.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$91.66
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cigna Commercial |
$522.07
|
| Rate for Payer: First Health Commercial |
$597.55
|
| Rate for Payer: Humana Commercial |
$534.65
|
| Rate for Payer: Humana KY Medicaid |
$91.66
|
| Rate for Payer: Humana Medicare Advantage |
$91.66
|
| Rate for Payer: Kentucky WC Medicaid |
$92.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$515.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$553.52
|
| Rate for Payer: Ohio Health Group HMO |
$471.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.01
|
| Rate for Payer: PHCS Commercial |
$603.84
|
| Rate for Payer: United Healthcare All Payer |
$553.52
|
|
|
OS JC Virus
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001841
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$514.56 |
| Rate for Payer: Aetna Commercial |
$412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$430.41
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cigna Commercial |
$444.88
|
| Rate for Payer: First Health Commercial |
$509.20
|
| Rate for Payer: Humana Commercial |
$455.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.68
|
| Rate for Payer: Ohio Health Group HMO |
$402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.84
|
| Rate for Payer: PHCS Commercial |
$514.56
|
| Rate for Payer: United Healthcare All Payer |
$471.68
|
|
|
OS JC Virus
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001841
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$514.56 |
| Rate for Payer: Aetna Commercial |
$412.72
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$430.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cigna Commercial |
$444.88
|
| Rate for Payer: First Health Commercial |
$509.20
|
| Rate for Payer: Humana Commercial |
$455.60
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.68
|
| Rate for Payer: Ohio Health Group HMO |
$402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.84
|
| Rate for Payer: PHCS Commercial |
$514.56
|
| Rate for Payer: United Healthcare All Payer |
$471.68
|
|
|
OS JO 1 AUTOANTIBODY
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
30001007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.42
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
OS JO 1 AUTOANTIBODY
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
30001007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$17.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$17.93
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Kentucky WC Medicaid |
$18.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
OS KAPPA FREE LIGHT CHAIN
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
30000456
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.66
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
OS KAPPA FREE LIGHT CHAIN
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
30000456
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| 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 |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
OS KETAMINE MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS KETAMINE MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS KETAMINE MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80357
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$8.94
|
| Rate for Payer: Kentucky WC Medicaid |
$9.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS KETAMINE MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80357
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS KETAMINE & NORKETAMINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
