|
OS LAMB IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000809
|
|
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 LAMOTRIGINE P/S
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 80175
|
| Hospital Charge Code |
30000034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$184.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
OS LAMOTRIGINE P/S
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 80175
|
| Hospital Charge Code |
30000034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$184.69
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
OS LATEX IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000692
|
|
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 LATEX IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000692
|
|
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 LDH-ISOENZYME
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
HCPCS 83625
|
| Hospital Charge Code |
30000437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem Medicaid |
$12.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.79
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Humana KY Medicaid |
$12.79
|
| Rate for Payer: Humana Medicare Advantage |
$12.79
|
| Rate for Payer: Kentucky WC Medicaid |
$12.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.23
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
OS LDH-ISOENZYME
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
HCPCS 83625
|
| Hospital Charge Code |
30000437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.10
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.23
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
OS LD TOTAL
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
30000436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$6.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.04
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$6.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.04
|
| Rate for Payer: Kentucky WC Medicaid |
$6.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.89
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
OS LD TOTAL
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
30000436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.89
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
OS LEAD (WHOLE BLOOD)
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
30000440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.90 |
| Max. Negotiated Rate |
$98.88 |
| Rate for Payer: Aetna Commercial |
$79.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$82.71
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$85.49
|
| Rate for Payer: First Health Commercial |
$97.85
|
| Rate for Payer: Humana Commercial |
$87.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.64
|
| Rate for Payer: Ohio Health Group HMO |
$77.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.07
|
| Rate for Payer: PHCS Commercial |
$98.88
|
| Rate for Payer: United Healthcare All Payer |
$90.64
|
|
|
OS LEAD (WHOLE BLOOD)
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
30000440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$98.88 |
| Rate for Payer: Aetna Commercial |
$79.31
|
| Rate for Payer: Anthem Medicaid |
$12.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$82.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.11
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$85.49
|
| Rate for Payer: First Health Commercial |
$97.85
|
| Rate for Payer: Humana Commercial |
$87.55
|
| Rate for Payer: Humana KY Medicaid |
$12.11
|
| Rate for Payer: Humana Medicare Advantage |
$12.11
|
| Rate for Payer: Kentucky WC Medicaid |
$12.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.64
|
| Rate for Payer: Ohio Health Group HMO |
$77.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.07
|
| Rate for Payer: PHCS Commercial |
$98.88
|
| Rate for Payer: United Healthcare All Payer |
$90.64
|
|
|
OS LEFLUNOMIDE
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS 80193
|
| Hospital Charge Code |
30001948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem Medicaid |
$38.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.57
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Humana KY Medicaid |
$38.57
|
| Rate for Payer: Humana Medicare Advantage |
$38.57
|
| Rate for Payer: Kentucky WC Medicaid |
$38.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.61
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
OS LEFLUNOMIDE
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS 80193
|
| Hospital Charge Code |
30001948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.70 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.01
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.61
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
OS LEGIONELL PNEUMONPHILIA AB
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 86713
|
| Hospital Charge Code |
30001192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem Medicaid |
$15.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.30
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Humana KY Medicaid |
$15.30
|
| Rate for Payer: Humana Medicare Advantage |
$15.30
|
| Rate for Payer: Kentucky WC Medicaid |
$15.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
OS LEGIONELL PNEUMONPHILIA AB
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 86713
|
| Hospital Charge Code |
30001192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.74
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
OS LEPTOSPIRA ANTIBODY
|
Facility
|
IP
|
$211.51
|
|
|
Service Code
|
HCPCS 86720
|
| Hospital Charge Code |
30002050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.45 |
| Max. Negotiated Rate |
$203.05 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$169.84
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna Commercial |
$175.55
|
| Rate for Payer: First Health Commercial |
$200.93
|
| Rate for Payer: Humana Commercial |
$179.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.13
|
| Rate for Payer: Ohio Health Group HMO |
$158.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$169.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.94
|
| Rate for Payer: PHCS Commercial |
$203.05
|
| Rate for Payer: United Healthcare All Payer |
$186.13
|
|
|
OS LEPTOSPIRA ANTIBODY
|
Facility
|
OP
|
$211.51
|
|
|
Service Code
|
HCPCS 86720
|
| Hospital Charge Code |
30002050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$203.05 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Anthem Medicaid |
$16.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$169.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.20
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna Commercial |
$175.55
|
| Rate for Payer: First Health Commercial |
$200.93
|
| Rate for Payer: Humana Commercial |
$179.78
|
| Rate for Payer: Humana KY Medicaid |
$16.20
|
| Rate for Payer: Humana Medicare Advantage |
$16.20
|
| Rate for Payer: Kentucky WC Medicaid |
$16.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.13
|
| Rate for Payer: Ohio Health Group HMO |
$158.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$169.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.94
|
| Rate for Payer: PHCS Commercial |
$203.05
|
| Rate for Payer: United Healthcare All Payer |
$186.13
|
|
|
OS LEUKOCYTE HISTAMINE RELEASE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 86343
|
| Hospital Charge Code |
30001931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$211.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.46
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Humana KY Medicaid |
$12.46
|
| Rate for Payer: Humana Medicare Advantage |
$12.46
|
| Rate for Payer: Kentucky WC Medicaid |
$12.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.47
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
OS LEUKOCYTE HISTAMINE RELEASE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 86343
|
| Hospital Charge Code |
30001931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$211.19
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.47
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
OS LEVEL 5 PATHOLOGY
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS 81404
|
| Hospital Charge Code |
30000208
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.90 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$194.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.16
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna Commercial |
$209.99
|
| Rate for Payer: First Health Commercial |
$240.35
|
| Rate for Payer: Humana Commercial |
$215.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$207.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$186.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$222.64
|
| Rate for Payer: Ohio Health Group HMO |
$189.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.57
|
| Rate for Payer: PHCS Commercial |
$242.88
|
| Rate for Payer: United Healthcare All Payer |
$222.64
|
|
|
OS LEVEL 5 PATHOLOGY
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
HCPCS 81404
|
| Hospital Charge Code |
30000208
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.57 |
| Max. Negotiated Rate |
$384.76 |
| Rate for Payer: Aetna Commercial |
$194.81
|
| Rate for Payer: Anthem Medicaid |
$274.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$274.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$384.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$274.83
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna Commercial |
$209.99
|
| Rate for Payer: First Health Commercial |
$240.35
|
| Rate for Payer: Humana Commercial |
$215.05
|
| Rate for Payer: Humana KY Medicaid |
$274.83
|
| Rate for Payer: Humana Medicare Advantage |
$274.83
|
| Rate for Payer: Kentucky WC Medicaid |
$277.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$207.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$186.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$222.64
|
| Rate for Payer: Ohio Health Group HMO |
$189.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.57
|
| Rate for Payer: PHCS Commercial |
$242.88
|
| Rate for Payer: United Healthcare All Payer |
$222.64
|
|
|
OS LEVEL 6 PATHOLOGY
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS 81405
|
| Hospital Charge Code |
30000209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.90 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$194.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.16
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna Commercial |
$209.99
|
| Rate for Payer: First Health Commercial |
$240.35
|
| Rate for Payer: Humana Commercial |
$215.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$207.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$186.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$222.64
|
| Rate for Payer: Ohio Health Group HMO |
$189.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.57
|
| Rate for Payer: PHCS Commercial |
$242.88
|
| Rate for Payer: United Healthcare All Payer |
$222.64
|
|
|
OS LEVEL 6 PATHOLOGY
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
HCPCS 81405
|
| Hospital Charge Code |
30000209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.57 |
| Max. Negotiated Rate |
$421.89 |
| Rate for Payer: Aetna Commercial |
$194.81
|
| Rate for Payer: Anthem Medicaid |
$301.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$301.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$421.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.35
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna Commercial |
$209.99
|
| Rate for Payer: First Health Commercial |
$240.35
|
| Rate for Payer: Humana Commercial |
$215.05
|
| Rate for Payer: Humana KY Medicaid |
$301.35
|
| Rate for Payer: Humana Medicare Advantage |
$301.35
|
| Rate for Payer: Kentucky WC Medicaid |
$304.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$207.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$186.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$307.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$222.64
|
| Rate for Payer: Ohio Health Group HMO |
$189.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.57
|
| Rate for Payer: PHCS Commercial |
$242.88
|
| Rate for Payer: United Healthcare All Payer |
$222.64
|
|
|
OS LEVETIRACETAM S
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
30000036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$175.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.08
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$189.24
|
| Rate for Payer: First Health Commercial |
$216.60
|
| Rate for Payer: Humana Commercial |
$193.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$168.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$200.64
|
| Rate for Payer: Ohio Health Group HMO |
$171.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.32
|
| Rate for Payer: PHCS Commercial |
$218.88
|
| Rate for Payer: United Healthcare All Payer |
$200.64
|
|
|
OS LEVETIRACETAM S
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
30000036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$175.56
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$189.24
|
| Rate for Payer: First Health Commercial |
$216.60
|
| Rate for Payer: Humana Commercial |
$193.80
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$168.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$200.64
|
| Rate for Payer: Ohio Health Group HMO |
$171.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.32
|
| Rate for Payer: PHCS Commercial |
$218.88
|
| Rate for Payer: United Healthcare All Payer |
$200.64
|
|
