|
OS METHYLENETETRAHYD MUT
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
30000192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$335.40 |
| Max. Negotiated Rate |
$1,073.28 |
| Rate for Payer: Aetna Commercial |
$860.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.75
|
| Rate for Payer: Cash Price |
$559.00
|
| Rate for Payer: Cigna Commercial |
$927.94
|
| Rate for Payer: First Health Commercial |
$1,062.10
|
| Rate for Payer: Humana Commercial |
$950.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$916.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$825.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$335.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$983.84
|
| Rate for Payer: Ohio Health Group HMO |
$838.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$771.42
|
| Rate for Payer: PHCS Commercial |
$1,073.28
|
| Rate for Payer: United Healthcare All Payer |
$983.84
|
|
|
OS METHYLENETETRAHYD MUT
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
30000192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.34 |
| Max. Negotiated Rate |
$1,073.28 |
| Rate for Payer: Aetna Commercial |
$860.86
|
| Rate for Payer: Anthem Medicaid |
$65.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$91.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.34
|
| Rate for Payer: Cash Price |
$559.00
|
| Rate for Payer: Cash Price |
$559.00
|
| Rate for Payer: Cigna Commercial |
$927.94
|
| Rate for Payer: First Health Commercial |
$1,062.10
|
| Rate for Payer: Humana Commercial |
$950.30
|
| Rate for Payer: Humana KY Medicaid |
$65.34
|
| Rate for Payer: Humana Medicare Advantage |
$65.34
|
| Rate for Payer: Kentucky WC Medicaid |
$65.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$916.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$825.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$983.84
|
| Rate for Payer: Ohio Health Group HMO |
$838.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$771.42
|
| Rate for Payer: PHCS Commercial |
$1,073.28
|
| Rate for Payer: United Healthcare All Payer |
$983.84
|
|
|
OS METHYLMALONIC ACID QT
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
30000461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$207.60 |
| Rate for Payer: Aetna Commercial |
$29.12
|
| Rate for Payer: Ambetter Exchange |
$21.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cigna Commercial |
$14.63
|
| Rate for Payer: Healthspan PPO |
$17.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.21
|
| Rate for Payer: Multiplan PHCS |
$207.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.57
|
| Rate for Payer: UHCCP Medicaid |
$121.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.21
|
|
|
OS METHYLMALONIC ACID QT
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
30000461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$332.16 |
| Rate for Payer: Aetna Commercial |
$266.42
|
| Rate for Payer: Anthem Medicaid |
$21.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$277.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.21
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cigna Commercial |
$287.18
|
| Rate for Payer: First Health Commercial |
$328.70
|
| Rate for Payer: Humana Commercial |
$294.10
|
| Rate for Payer: Humana KY Medicaid |
$21.21
|
| Rate for Payer: Humana Medicare Advantage |
$21.21
|
| Rate for Payer: Kentucky WC Medicaid |
$21.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$283.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$255.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$304.48
|
| Rate for Payer: Ohio Health Group HMO |
$259.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$301.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.74
|
| Rate for Payer: PHCS Commercial |
$332.16
|
| Rate for Payer: United Healthcare All Payer |
$304.48
|
|
|
OS METHYLMALONIC ACID QT
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
30000461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$332.16 |
| Rate for Payer: Aetna Commercial |
$266.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$277.84
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cigna Commercial |
$287.18
|
| Rate for Payer: First Health Commercial |
$328.70
|
| Rate for Payer: Humana Commercial |
$294.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$283.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$255.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$304.48
|
| Rate for Payer: Ohio Health Group HMO |
$259.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$301.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.74
|
| Rate for Payer: PHCS Commercial |
$332.16
|
| Rate for Payer: United Healthcare All Payer |
$304.48
|
|
|
OS METHYLPHENIADATE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80360
|
| Hospital Charge Code |
30000146
|
|
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 METHYLPHENIADATE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000146
|
|
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 METHYLPHENIADATE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000146
|
|
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 METHYLPHENIADATE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80360
|
| Hospital Charge Code |
30000146
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Multiplan PHCS |
$15.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.20
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
|
|
OS METHYLPHENIADATE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80360
|
| Hospital Charge Code |
30000146
|
|
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 Methylphenidate and MTB, Ur
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS 80360
|
| Hospital Charge Code |
30001869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$177.46
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cigna Commercial |
$183.43
|
| Rate for Payer: First Health Commercial |
$209.95
|
| Rate for Payer: Humana Commercial |
$187.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$181.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$194.48
|
| Rate for Payer: Ohio Health Group HMO |
$165.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$192.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.49
|
| Rate for Payer: PHCS Commercial |
$212.16
|
| Rate for Payer: United Healthcare All Payer |
$194.48
|
|
|
OS Methylphenidate and MTB, Ur
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 80360
|
| Hospital Charge Code |
30001869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Anthem Medicaid |
$76.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$177.46
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cigna Commercial |
$183.43
|
| Rate for Payer: First Health Commercial |
$209.95
|
| Rate for Payer: Humana Commercial |
$187.85
|
| Rate for Payer: Humana KY Medicaid |
$76.00
|
| Rate for Payer: Kentucky WC Medicaid |
$76.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$181.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$194.48
|
| Rate for Payer: Ohio Health Group HMO |
$165.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$192.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.49
|
| Rate for Payer: PHCS Commercial |
$212.16
|
| Rate for Payer: United Healthcare All Payer |
$194.48
|
|
|
OS Methylphenidate and MTB, Ur
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$177.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cigna Commercial |
$183.43
|
| Rate for Payer: First Health Commercial |
$209.95
|
| Rate for Payer: Humana Commercial |
$187.85
|
| 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 |
$181.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$194.48
|
| Rate for Payer: Ohio Health Group HMO |
$165.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$192.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.49
|
| Rate for Payer: PHCS Commercial |
$212.16
|
| Rate for Payer: United Healthcare All Payer |
$194.48
|
|
|
OS Methylphenidate and MTB, Ur
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$177.46
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cigna Commercial |
$183.43
|
| Rate for Payer: First Health Commercial |
$209.95
|
| Rate for Payer: Humana Commercial |
$187.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$181.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$194.48
|
| Rate for Payer: Ohio Health Group HMO |
$165.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$192.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.49
|
| Rate for Payer: PHCS Commercial |
$212.16
|
| Rate for Payer: United Healthcare All Payer |
$194.48
|
|
|
OS METHYLPHENIDATE MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000147
|
|
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 METHYLPHENIDATE MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000147
|
|
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 METHYLPHENIDATE MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80360
|
| Hospital Charge Code |
30000147
|
|
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 METHYLPHENIDATE MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80360
|
| Hospital Charge Code |
30000147
|
|
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 M. GENITALIUM AMP PROBE
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 87563
|
| Hospital Charge Code |
30001983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
OS M. GENITALIUM AMP PROBE
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 87563
|
| Hospital Charge Code |
30001983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| 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 |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
OS MH DRUG SCREEN TESTING MC (
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
30002049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$351.36 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$293.90
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$303.78
|
| Rate for Payer: First Health Commercial |
$347.70
|
| Rate for Payer: Humana Commercial |
$311.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.08
|
| Rate for Payer: Ohio Health Group HMO |
$274.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.54
|
| Rate for Payer: PHCS Commercial |
$351.36
|
| Rate for Payer: United Healthcare All Payer |
$322.08
|
|
|
OS MH DRUG SCREEN TESTING MC (
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
30002049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$351.36 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Anthem Medicaid |
$198.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$198.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$293.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$278.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.74
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$303.78
|
| Rate for Payer: First Health Commercial |
$347.70
|
| Rate for Payer: Humana Commercial |
$311.10
|
| Rate for Payer: Humana KY Medicaid |
$198.74
|
| Rate for Payer: Humana Medicare Advantage |
$198.74
|
| Rate for Payer: Kentucky WC Medicaid |
$200.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$202.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.08
|
| Rate for Payer: Ohio Health Group HMO |
$274.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.54
|
| Rate for Payer: PHCS Commercial |
$351.36
|
| Rate for Payer: United Healthcare All Payer |
$322.08
|
|
|
OS MICROALBUMINU URINE QUA
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
30000228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$127.68 |
| Rate for Payer: Aetna Commercial |
$102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.80
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$110.39
|
| Rate for Payer: First Health Commercial |
$126.35
|
| Rate for Payer: Humana Commercial |
$113.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.04
|
| Rate for Payer: Ohio Health Group HMO |
$99.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.77
|
| Rate for Payer: PHCS Commercial |
$127.68
|
| Rate for Payer: United Healthcare All Payer |
$117.04
|
|
|
OS MICROALBUMINU URINE QUA
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
30000228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$127.68 |
| Rate for Payer: Aetna Commercial |
$102.41
|
| Rate for Payer: Anthem Medicaid |
$5.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.78
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$110.39
|
| Rate for Payer: First Health Commercial |
$126.35
|
| Rate for Payer: Humana Commercial |
$113.05
|
| Rate for Payer: Humana KY Medicaid |
$5.78
|
| Rate for Payer: Humana Medicare Advantage |
$5.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.04
|
| Rate for Payer: Ohio Health Group HMO |
$99.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.77
|
| Rate for Payer: PHCS Commercial |
$127.68
|
| Rate for Payer: United Healthcare All Payer |
$117.04
|
|
|
OS MICRODISSECTION LASER
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS 88380
|
| Hospital Charge Code |
30001860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$402.90 |
| Max. Negotiated Rate |
$1,289.28 |
| Rate for Payer: Aetna Commercial |
$1,034.11
|
| Rate for Payer: Anthem Medicaid |
$461.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,078.43
|
| Rate for Payer: Cash Price |
$671.50
|
| Rate for Payer: Cigna Commercial |
$1,114.69
|
| Rate for Payer: First Health Commercial |
$1,275.85
|
| Rate for Payer: Humana Commercial |
$1,141.55
|
| Rate for Payer: Humana KY Medicaid |
$461.86
|
| Rate for Payer: Kentucky WC Medicaid |
$466.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,101.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$991.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$471.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,181.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,007.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,074.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$926.67
|
| Rate for Payer: PHCS Commercial |
$1,289.28
|
| Rate for Payer: United Healthcare All Payer |
$1,181.84
|
|
