|
OS OPIATES URINE
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$204.48 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.04
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$176.79
|
| Rate for Payer: First Health Commercial |
$202.35
|
| Rate for Payer: Humana Commercial |
$181.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$174.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$187.44
|
| Rate for Payer: Ohio Health Group HMO |
$159.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.97
|
| Rate for Payer: PHCS Commercial |
$204.48
|
| Rate for Payer: United Healthcare All Payer |
$187.44
|
|
|
OS OPIATES URINE
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$204.48 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.04
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$176.79
|
| Rate for Payer: First Health Commercial |
$202.35
|
| Rate for Payer: Humana Commercial |
$181.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$174.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$187.44
|
| Rate for Payer: Ohio Health Group HMO |
$159.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.97
|
| Rate for Payer: PHCS Commercial |
$204.48
|
| Rate for Payer: United Healthcare All Payer |
$187.44
|
|
|
OS OPIATES URINE
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$204.48 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Anthem Medicaid |
$73.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.04
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$176.79
|
| Rate for Payer: First Health Commercial |
$202.35
|
| Rate for Payer: Humana Commercial |
$181.05
|
| Rate for Payer: Humana KY Medicaid |
$73.25
|
| Rate for Payer: Kentucky WC Medicaid |
$74.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$174.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$74.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$187.44
|
| Rate for Payer: Ohio Health Group HMO |
$159.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.97
|
| Rate for Payer: PHCS Commercial |
$204.48
|
| Rate for Payer: United Healthcare All Payer |
$187.44
|
|
|
OS OPIATES URINE
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$149.10 |
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Multiplan PHCS |
$127.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$149.10
|
| Rate for Payer: UHCCP Medicaid |
$74.55
|
|
|
OS OPIODS
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80362
|
| Hospital Charge Code |
30001823
|
|
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 OPIODS
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001823
|
|
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 OPIODS
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80362
|
| Hospital Charge Code |
30001823
|
|
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 OPIODS
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001823
|
|
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 OPIODS MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000153
|
|
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 OPIODS MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000153
|
|
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 OPIODS MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80364
|
| Hospital Charge Code |
30000153
|
|
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 OPIODS MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80364
|
| Hospital Charge Code |
30000153
|
|
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 OPIOIDS URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000152
|
|
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 OPIOIDS URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80364
|
| Hospital Charge Code |
30000152
|
|
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 OPIOIDS URINE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80364
|
| Hospital Charge Code |
30000152
|
|
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 OPIOIDS URINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000152
|
|
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 OPIOIDS URINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80364
|
| Hospital Charge Code |
30000152
|
|
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 OPIO & OPIA (NALOXONE) URIN
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
HCPCS 80362
|
| Hospital Charge Code |
30001840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$416.64 |
| Rate for Payer: Aetna Commercial |
$334.18
|
| Rate for Payer: Anthem Medicaid |
$149.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$360.22
|
| Rate for Payer: First Health Commercial |
$412.30
|
| Rate for Payer: Humana Commercial |
$368.90
|
| Rate for Payer: Humana KY Medicaid |
$149.25
|
| Rate for Payer: Kentucky WC Medicaid |
$150.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$355.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$320.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$152.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$381.92
|
| Rate for Payer: Ohio Health Group HMO |
$325.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$377.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.46
|
| Rate for Payer: PHCS Commercial |
$416.64
|
| Rate for Payer: United Healthcare All Payer |
$381.92
|
|
|
OS OPIO & OPIA (NALOXONE) URIN
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$416.64 |
| Rate for Payer: Aetna Commercial |
$334.18
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$360.22
|
| Rate for Payer: First Health Commercial |
$412.30
|
| Rate for Payer: Humana Commercial |
$368.90
|
| 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 |
$355.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$320.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$381.92
|
| Rate for Payer: Ohio Health Group HMO |
$325.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$377.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.46
|
| Rate for Payer: PHCS Commercial |
$416.64
|
| Rate for Payer: United Healthcare All Payer |
$381.92
|
|
|
OS OPIO & OPIA (NALOXONE) URIN
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
HCPCS 80362
|
| Hospital Charge Code |
30001840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$416.64 |
| Rate for Payer: Aetna Commercial |
$334.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$360.22
|
| Rate for Payer: First Health Commercial |
$412.30
|
| Rate for Payer: Humana Commercial |
$368.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$355.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$320.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$381.92
|
| Rate for Payer: Ohio Health Group HMO |
$325.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$377.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.46
|
| Rate for Payer: PHCS Commercial |
$416.64
|
| Rate for Payer: United Healthcare All Payer |
$381.92
|
|
|
OS OPIO & OPIA (NALOXONE) URIN
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$416.64 |
| Rate for Payer: Aetna Commercial |
$334.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$360.22
|
| Rate for Payer: First Health Commercial |
$412.30
|
| Rate for Payer: Humana Commercial |
$368.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$355.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$320.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$381.92
|
| Rate for Payer: Ohio Health Group HMO |
$325.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$377.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.46
|
| Rate for Payer: PHCS Commercial |
$416.64
|
| Rate for Payer: United Healthcare All Payer |
$381.92
|
|
|
OS ORANGE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000675
|
|
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 ORANGE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000675
|
|
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 ORGANIC ACIDS SCREEN URINE
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS 83919
|
| Hospital Charge Code |
30000460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: Aetna Commercial |
$249.48
|
| Rate for Payer: Anthem Medicaid |
$16.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.45
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$268.92
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Humana Commercial |
$275.40
|
| Rate for Payer: Humana KY Medicaid |
$16.45
|
| Rate for Payer: Humana Medicare Advantage |
$16.45
|
| Rate for Payer: Kentucky WC Medicaid |
$16.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$285.12
|
| Rate for Payer: Ohio Health Group HMO |
$243.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.56
|
| Rate for Payer: PHCS Commercial |
$311.04
|
| Rate for Payer: United Healthcare All Payer |
$285.12
|
|
|
OS ORGANIC ACIDS SCREEN URINE
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
HCPCS 83919
|
| Hospital Charge Code |
30000460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: Aetna Commercial |
$249.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.17
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$268.92
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Humana Commercial |
$275.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$285.12
|
| Rate for Payer: Ohio Health Group HMO |
$243.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.56
|
| Rate for Payer: PHCS Commercial |
$311.04
|
| Rate for Payer: United Healthcare All Payer |
$285.12
|
|
