|
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
|
|
|
OS KETAMINE & NORKETAMINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80357
|
| 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
|
|
|
OS KETAMINE & NORKETAMINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80357
|
| 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 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 & NORKETAMINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000136
|
|
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 KETOSTEROID FRACT 17 URINE
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 83593
|
| Hospital Charge Code |
30000433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.90 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna Commercial |
$187.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.13
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$201.69
|
| Rate for Payer: First Health Commercial |
$230.85
|
| Rate for Payer: Humana Commercial |
$206.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.84
|
| Rate for Payer: Ohio Health Group HMO |
$182.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.67
|
| Rate for Payer: PHCS Commercial |
$233.28
|
| Rate for Payer: United Healthcare All Payer |
$213.84
|
|
|
OS KETOSTEROID FRACT 17 URINE
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 83593
|
| Hospital Charge Code |
30000433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna Commercial |
$187.11
|
| Rate for Payer: Anthem Medicaid |
$28.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$201.69
|
| Rate for Payer: First Health Commercial |
$230.85
|
| Rate for Payer: Humana Commercial |
$206.55
|
| Rate for Payer: Humana KY Medicaid |
$28.50
|
| Rate for Payer: Humana Medicare Advantage |
$28.50
|
| Rate for Payer: Kentucky WC Medicaid |
$28.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.84
|
| Rate for Payer: Ohio Health Group HMO |
$182.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.67
|
| Rate for Payer: PHCS Commercial |
$233.28
|
| Rate for Payer: United Healthcare All Payer |
$213.84
|
|
|
OS KIDNEY (RED) BEAN
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30001961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| 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 |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
OS KIDNEY (RED) BEAN
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30001961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
OS KIT GENE ANALYS D816 VARIAN
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 81273
|
| Hospital Charge Code |
30001946
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$277.50 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$742.77
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.25
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
OS KIT GENE ANALYS D816 VARIAN
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 81273
|
| Hospital Charge Code |
30001946
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.87 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$124.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$124.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$742.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$174.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$124.87
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Humana KY Medicaid |
$124.87
|
| Rate for Payer: Humana Medicare Advantage |
$124.87
|
| Rate for Payer: Kentucky WC Medicaid |
$126.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$127.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.25
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
OS KIT GENE TARGETED SEQ ANALY
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 81272
|
| Hospital Charge Code |
30002001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$943.52
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
OS KIT GENE TARGETED SEQ ANALY
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 81272
|
| Hospital Charge Code |
30002001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$329.51 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem Medicaid |
$329.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$943.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$329.51
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Humana KY Medicaid |
$329.51
|
| Rate for Payer: Humana Medicare Advantage |
$329.51
|
| Rate for Payer: Kentucky WC Medicaid |
$332.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$336.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
OS LACOSAMIDE
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.18 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| 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 |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
OS LACOSAMIDE
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 80339
|
| Hospital Charge Code |
30000102
|
|
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 Medicaid |
$94.57
|
| 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: Humana KY Medicaid |
$94.57
|
| Rate for Payer: Kentucky WC Medicaid |
$95.53
|
| 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: Molina Healthcare Medicaid |
$96.47
|
| 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 LACOSAMIDE
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
OS LACOSAMIDE
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000102
|
|
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 LACOSAMIDE
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$220.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| 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 |
$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 |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| 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 LACOSAMIDE
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 80339
|
| Hospital Charge Code |
30000102
|
|
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 LACTOFERRIN FECAL QNT
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 83631
|
| Hospital Charge Code |
30000439
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem Medicaid |
$19.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.63
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Humana KY Medicaid |
$19.63
|
| Rate for Payer: Humana Medicare Advantage |
$19.63
|
| Rate for Payer: Kentucky WC Medicaid |
$19.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.25
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
OS LACTOFERRIN FECAL QNT
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 83631
|
| Hospital Charge Code |
30000439
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.68
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.25
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
OS LACTOTYPE
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS 81400
|
| Hospital Charge Code |
30000204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$328.32 |
| Rate for Payer: Aetna Commercial |
$263.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.63
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$283.86
|
| Rate for Payer: First Health Commercial |
$324.90
|
| Rate for Payer: Humana Commercial |
$290.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$280.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$252.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.96
|
| Rate for Payer: Ohio Health Group HMO |
$256.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$297.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.98
|
| Rate for Payer: PHCS Commercial |
$328.32
|
| Rate for Payer: United Healthcare All Payer |
$300.96
|
|
|
OS LACTOTYPE
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS 81400
|
| Hospital Charge Code |
30000204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$328.32 |
| Rate for Payer: Aetna Commercial |
$263.34
|
| Rate for Payer: Anthem Medicaid |
$63.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$63.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$89.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.96
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$283.86
|
| Rate for Payer: First Health Commercial |
$324.90
|
| Rate for Payer: Humana Commercial |
$290.70
|
| Rate for Payer: Humana KY Medicaid |
$63.96
|
| Rate for Payer: Humana Medicare Advantage |
$63.96
|
| Rate for Payer: Kentucky WC Medicaid |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$280.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$252.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.96
|
| Rate for Payer: Ohio Health Group HMO |
$256.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$297.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.98
|
| Rate for Payer: PHCS Commercial |
$328.32
|
| Rate for Payer: United Healthcare All Payer |
$300.96
|
|
|
OS LAMBDA FREE LIGHT CHAIN
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
30000457
|
|
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 LAMBDA FREE LIGHT CHAIN
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
30000457
|
|
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 LAMB IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000809
|
|
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
|
|
