|
OS MOG-IGG1 ANTB FLO CYTMTRY E
|
Facility
|
IP
|
$787.50
|
|
|
Service Code
|
HCPCS 86363
|
| Hospital Charge Code |
30002017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.36
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.38
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
OS MOG-IGG1 ANTB FLO CYTMTRY E
|
Facility
|
OP
|
$787.50
|
|
|
Service Code
|
HCPCS 86363
|
| Hospital Charge Code |
30002017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem Medicaid |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$52.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.73
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Humana KY Medicaid |
$37.73
|
| Rate for Payer: Humana Medicare Advantage |
$37.73
|
| Rate for Payer: Kentucky WC Medicaid |
$38.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.38
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
OSMOLALITY SERUM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
30000462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna Commercial |
$75.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.69
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$81.34
|
| Rate for Payer: First Health Commercial |
$93.10
|
| Rate for Payer: Humana Commercial |
$83.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.24
|
| Rate for Payer: Ohio Health Group HMO |
$73.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.62
|
| Rate for Payer: PHCS Commercial |
$94.08
|
| Rate for Payer: United Healthcare All Payer |
$86.24
|
|
|
OSMOLALITY SERUM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
30000462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna Commercial |
$75.46
|
| Rate for Payer: Anthem Medicaid |
$6.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.61
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$81.34
|
| Rate for Payer: First Health Commercial |
$93.10
|
| Rate for Payer: Humana Commercial |
$83.30
|
| Rate for Payer: Humana KY Medicaid |
$6.61
|
| Rate for Payer: Humana Medicare Advantage |
$6.61
|
| Rate for Payer: Kentucky WC Medicaid |
$6.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.24
|
| Rate for Payer: Ohio Health Group HMO |
$73.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.62
|
| Rate for Payer: PHCS Commercial |
$94.08
|
| Rate for Payer: United Healthcare All Payer |
$86.24
|
|
|
OSMOLALITY URINE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
30000463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem Medicaid |
$6.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.82
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Humana KY Medicaid |
$6.82
|
| Rate for Payer: Humana Medicare Advantage |
$6.82
|
| Rate for Payer: Kentucky WC Medicaid |
$6.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
OSMOLALITY URINE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
30000463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.03
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
OS MOLD PANEL IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000917
|
|
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 MOLD PANEL IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000917
|
|
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 MOLECLA CYTOGNTIS EA PRBE1
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS MOLECLA CYTOGNTIS EA PRBE1
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS MOLECLA CYTOGNTIS EA PRBE2
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS MOLECLA CYTOGNTIS EA PRBE2
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OSMOLITE 1.2CAL 1000ML
|
Facility
|
IP
|
$70.44
|
|
|
Service Code
|
NDC 70074062698
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$67.62 |
| Rate for Payer: Aetna Commercial |
$54.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.94
|
| Rate for Payer: Cash Price |
$35.22
|
| Rate for Payer: Cigna Commercial |
$58.47
|
| Rate for Payer: First Health Commercial |
$66.92
|
| Rate for Payer: Humana Commercial |
$59.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.99
|
| Rate for Payer: Ohio Health Group HMO |
$52.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.60
|
| Rate for Payer: PHCS Commercial |
$67.62
|
| Rate for Payer: United Healthcare All Payer |
$61.99
|
|
|
OSMOLITE 1.2CAL 1000ML
|
Facility
|
IP
|
$91.19
|
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$87.54 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.13
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cigna Commercial |
$75.69
|
| Rate for Payer: First Health Commercial |
$86.63
|
| Rate for Payer: Humana Commercial |
$77.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.25
|
| Rate for Payer: Ohio Health Group HMO |
$68.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.92
|
| Rate for Payer: PHCS Commercial |
$87.54
|
| Rate for Payer: United Healthcare All Payer |
$80.25
|
|
|
OSMOLITE 1.2CAL 1000ML
|
Facility
|
OP
|
$70.44
|
|
|
Service Code
|
NDC 70074062698
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$67.62 |
| Rate for Payer: Aetna Commercial |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$24.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.94
|
| Rate for Payer: Cash Price |
$35.22
|
| Rate for Payer: Cigna Commercial |
$58.47
|
| Rate for Payer: First Health Commercial |
$66.92
|
| Rate for Payer: Humana Commercial |
$59.87
|
| Rate for Payer: Humana KY Medicaid |
$24.22
|
| Rate for Payer: Kentucky WC Medicaid |
$24.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.99
|
| Rate for Payer: Ohio Health Group HMO |
$52.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.60
|
| Rate for Payer: PHCS Commercial |
$67.62
|
| Rate for Payer: United Healthcare All Payer |
$61.99
|
|
|
OSMOLITE 1.2CAL 1000ML
|
Facility
|
OP
|
$91.19
|
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$87.54 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Anthem Medicaid |
$31.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.13
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cigna Commercial |
$75.69
|
| Rate for Payer: First Health Commercial |
$86.63
|
| Rate for Payer: Humana Commercial |
$77.51
|
| Rate for Payer: Humana KY Medicaid |
$31.36
|
| Rate for Payer: Kentucky WC Medicaid |
$31.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.25
|
| Rate for Payer: Ohio Health Group HMO |
$68.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.92
|
| Rate for Payer: PHCS Commercial |
$87.54
|
| Rate for Payer: United Healthcare All Payer |
$80.25
|
|
|
OSMOLITE 1 CAL 1000ML
|
Facility
|
IP
|
$91.19
|
|
| Hospital Charge Code |
27000239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$87.54 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.13
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cigna Commercial |
$75.69
|
| Rate for Payer: First Health Commercial |
$86.63
|
| Rate for Payer: Humana Commercial |
$77.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.25
|
| Rate for Payer: Ohio Health Group HMO |
$68.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.92
|
| Rate for Payer: PHCS Commercial |
$87.54
|
| Rate for Payer: United Healthcare All Payer |
$80.25
|
|
|
OSMOLITE 1 CAL 1000ML
|
Facility
|
OP
|
$91.19
|
|
| Hospital Charge Code |
27000239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$87.54 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Anthem Medicaid |
$31.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.13
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cigna Commercial |
$75.69
|
| Rate for Payer: First Health Commercial |
$86.63
|
| Rate for Payer: Humana Commercial |
$77.51
|
| Rate for Payer: Humana KY Medicaid |
$31.36
|
| Rate for Payer: Kentucky WC Medicaid |
$31.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.25
|
| Rate for Payer: Ohio Health Group HMO |
$68.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.92
|
| Rate for Payer: PHCS Commercial |
$87.54
|
| Rate for Payer: United Healthcare All Payer |
$80.25
|
|
|
OSMOLITE 237
|
Facility
|
IP
|
$65.18
|
|
|
Service Code
|
HCPCS B4150
|
| Hospital Charge Code |
25004534
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$62.57 |
| Rate for Payer: Aetna Commercial |
$50.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.84
|
| Rate for Payer: Cash Price |
$32.59
|
| Rate for Payer: Cigna Commercial |
$54.10
|
| Rate for Payer: First Health Commercial |
$61.92
|
| Rate for Payer: Humana Commercial |
$55.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.36
|
| Rate for Payer: Ohio Health Group HMO |
$48.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.97
|
| Rate for Payer: PHCS Commercial |
$62.57
|
| Rate for Payer: United Healthcare All Payer |
$57.36
|
|
|
OSMOLITE 237
|
Facility
|
OP
|
$65.18
|
|
|
Service Code
|
HCPCS B4150
|
| Hospital Charge Code |
25004534
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$62.57 |
| Rate for Payer: Aetna Commercial |
$50.19
|
| Rate for Payer: Anthem Medicaid |
$22.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.84
|
| Rate for Payer: Cash Price |
$32.59
|
| Rate for Payer: Cigna Commercial |
$54.10
|
| Rate for Payer: First Health Commercial |
$61.92
|
| Rate for Payer: Humana Commercial |
$55.40
|
| Rate for Payer: Humana KY Medicaid |
$22.42
|
| Rate for Payer: Kentucky WC Medicaid |
$22.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.36
|
| Rate for Payer: Ohio Health Group HMO |
$48.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.97
|
| Rate for Payer: PHCS Commercial |
$62.57
|
| Rate for Payer: United Healthcare All Payer |
$57.36
|
|
|
OS MONKEYPOX VIRUS EACH
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 87593
|
| Hospital Charge Code |
30002030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.80
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
OS MONKEYPOX VIRUS EACH
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 87593
|
| Hospital Charge Code |
30002030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$51.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.31
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Humana KY Medicaid |
$51.31
|
| Rate for Payer: Humana Medicare Advantage |
$51.31
|
| Rate for Payer: Kentucky WC Medicaid |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.80
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
OS MONONUCLEAR CELL ANTIGEN
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
30002072
|
|
Hospital Revenue Code
|
302
|
| 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 MONONUCLEAR CELL ANTIGEN
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
30002072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$26.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.78
|
| 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 |
$26.78
|
| Rate for Payer: Humana Medicare Advantage |
$26.78
|
| Rate for Payer: Kentucky WC Medicaid |
$27.05
|
| 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 |
$32.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.32
|
| 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 MOPATH PROCEDURE LEVEL 1
|
Facility
|
IP
|
$548.70
|
|
|
Service Code
|
HCPCS 81400
|
| Hospital Charge Code |
30002018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$164.61 |
| Max. Negotiated Rate |
$526.75 |
| Rate for Payer: Aetna Commercial |
$422.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.61
|
| Rate for Payer: Cash Price |
$274.35
|
| Rate for Payer: Cigna Commercial |
$455.42
|
| Rate for Payer: First Health Commercial |
$521.26
|
| Rate for Payer: Humana Commercial |
$466.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.86
|
| Rate for Payer: Ohio Health Group HMO |
$411.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.60
|
| Rate for Payer: PHCS Commercial |
$526.75
|
| Rate for Payer: United Healthcare All Payer |
$482.86
|
|
