|
OS NEURONAL V-G K+ CHANN AB S
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
30000388
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.76
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.95
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
OS NICOTINE & METABOLITES
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.86
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
OS NICOTINE & METABOLITES
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| 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 |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.86
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
OS NICOTINE & METABOLITES
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 80323
|
| Hospital Charge Code |
30000080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.86
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
OS NICOTINE & METABOLITES
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 80323
|
| Hospital Charge Code |
30000080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$66.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Humana KY Medicaid |
$66.72
|
| Rate for Payer: Kentucky WC Medicaid |
$67.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.86
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
OS NK CELLS TOTAL COUNT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86357
|
| Hospital Charge Code |
30001085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$52.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.73
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| 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 |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OS NK CELLS TOTAL COUNT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86357
|
| Hospital Charge Code |
30001085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OS NKX2 3 SNP
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000213
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.58
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
OS NKX2 3 SNP
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000213
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem Medicaid |
$62.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Humana KY Medicaid |
$62.59
|
| Rate for Payer: Kentucky WC Medicaid |
$63.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.58
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
OS NMDA-R, LGI1 IGG CBA S
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$341.88
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$356.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$368.52
|
| Rate for Payer: First Health Commercial |
$421.80
|
| Rate for Payer: Humana Commercial |
$377.40
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$327.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$390.72
|
| Rate for Payer: Ohio Health Group HMO |
$333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$306.36
|
| Rate for Payer: PHCS Commercial |
$426.24
|
| Rate for Payer: United Healthcare All Payer |
$390.72
|
|
|
OS NMDA-R, LGI1 IGG CBA S
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$341.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$356.53
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$368.52
|
| Rate for Payer: First Health Commercial |
$421.80
|
| Rate for Payer: Humana Commercial |
$377.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$327.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$390.72
|
| Rate for Payer: Ohio Health Group HMO |
$333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$306.36
|
| Rate for Payer: PHCS Commercial |
$426.24
|
| Rate for Payer: United Healthcare All Payer |
$390.72
|
|
|
OS NMR LIPOPROTEIN
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 83704
|
| Hospital Charge Code |
30000444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$172.65
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
OS NMR LIPOPROTEIN
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 83704
|
| Hospital Charge Code |
30000444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem Medicaid |
$34.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$172.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$47.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.19
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Humana KY Medicaid |
$34.19
|
| Rate for Payer: Humana Medicare Advantage |
$34.19
|
| Rate for Payer: Kentucky WC Medicaid |
$34.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
OS NOD2 (SNP 8 12 13)
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
30000205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.44
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS NOD2 (SNP 8 12 13)
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
30000205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem Medicaid |
$137.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$191.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Humana KY Medicaid |
$137.00
|
| Rate for Payer: Humana Medicare Advantage |
$137.00
|
| Rate for Payer: Kentucky WC Medicaid |
$138.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.44
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS Non TB Mycobacteria PCR
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS 87551
|
| Hospital Charge Code |
30001989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$480.96 |
| Rate for Payer: Aetna Commercial |
$385.77
|
| Rate for Payer: Anthem Medicaid |
$48.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$48.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$67.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.24
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cigna Commercial |
$415.83
|
| Rate for Payer: First Health Commercial |
$475.95
|
| Rate for Payer: Humana Commercial |
$425.85
|
| Rate for Payer: Humana KY Medicaid |
$48.24
|
| Rate for Payer: Humana Medicare Advantage |
$48.24
|
| Rate for Payer: Kentucky WC Medicaid |
$48.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.88
|
| Rate for Payer: Ohio Health Group HMO |
$375.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.69
|
| Rate for Payer: PHCS Commercial |
$480.96
|
| Rate for Payer: United Healthcare All Payer |
$440.88
|
|
|
OS Non TB Mycobacteria PCR
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS 87551
|
| Hospital Charge Code |
30001989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.30 |
| Max. Negotiated Rate |
$480.96 |
| Rate for Payer: Aetna Commercial |
$385.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.30
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cigna Commercial |
$415.83
|
| Rate for Payer: First Health Commercial |
$475.95
|
| Rate for Payer: Humana Commercial |
$425.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.88
|
| Rate for Payer: Ohio Health Group HMO |
$375.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.69
|
| Rate for Payer: PHCS Commercial |
$480.96
|
| Rate for Payer: United Healthcare All Payer |
$440.88
|
|
|
OS NORCLOZAPINE S
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30000060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem Medicaid |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Humana KY Medicaid |
$18.64
|
| Rate for Payer: Humana Medicare Advantage |
$18.64
|
| Rate for Payer: Kentucky WC Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS NORCLOZAPINE S
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30000060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS NORTRIPTYLINE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS G6037
|
| Hospital Charge Code |
30001558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.12
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$33.20
|
| Rate for Payer: First Health Commercial |
$38.00
|
| Rate for Payer: Humana Commercial |
$34.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.20
|
| Rate for Payer: Ohio Health Group HMO |
$30.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.60
|
| Rate for Payer: PHCS Commercial |
$38.40
|
| Rate for Payer: United Healthcare All Payer |
$35.20
|
|
|
OS NORTRIPTYLINE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS G6037
|
| Hospital Charge Code |
30001558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Anthem Medicaid |
$13.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.12
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$33.20
|
| Rate for Payer: First Health Commercial |
$38.00
|
| Rate for Payer: Humana Commercial |
$34.00
|
| Rate for Payer: Humana KY Medicaid |
$13.76
|
| Rate for Payer: Kentucky WC Medicaid |
$13.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.20
|
| Rate for Payer: Ohio Health Group HMO |
$30.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.60
|
| Rate for Payer: PHCS Commercial |
$38.40
|
| Rate for Payer: United Healthcare All Payer |
$35.20
|
|
|
OS NORTRIPTYLINE SERUM
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
OS NORTRIPTYLINE SERUM
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.87 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
OS NORTRIPTYLINE SERUM
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
30000091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
OS NORTRIPTYLINE SERUM
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
30000091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$42.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Humana KY Medicaid |
$42.30
|
| Rate for Payer: Kentucky WC Medicaid |
$42.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
