|
OS PARATHYROID HORM REL PEPTI
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000271
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$285.06
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.95
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
OS PARIETAL CELL AB IGG S
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000374
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.16
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.03
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
OS PARIETAL CELL AB IGG S
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000374
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Humana KY Medicaid |
$11.53
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Kentucky WC Medicaid |
$11.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.03
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
OS PAROXETINE
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS 80332
|
| Hospital Charge Code |
30001949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$137.28 |
| Rate for Payer: Aetna Commercial |
$110.11
|
| Rate for Payer: Anthem Medicaid |
$49.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.83
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$118.69
|
| Rate for Payer: First Health Commercial |
$135.85
|
| Rate for Payer: Humana Commercial |
$121.55
|
| Rate for Payer: Humana KY Medicaid |
$49.18
|
| Rate for Payer: Kentucky WC Medicaid |
$49.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$117.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$105.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$125.84
|
| Rate for Payer: Ohio Health Group HMO |
$107.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$98.67
|
| Rate for Payer: PHCS Commercial |
$137.28
|
| Rate for Payer: United Healthcare All Payer |
$125.84
|
|
|
OS PAROXETINE
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS 80332
|
| Hospital Charge Code |
30001949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$137.28 |
| Rate for Payer: Aetna Commercial |
$110.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.83
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$118.69
|
| Rate for Payer: First Health Commercial |
$135.85
|
| Rate for Payer: Humana Commercial |
$121.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$117.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$105.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$125.84
|
| Rate for Payer: Ohio Health Group HMO |
$107.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$98.67
|
| Rate for Payer: PHCS Commercial |
$137.28
|
| Rate for Payer: United Healthcare All Payer |
$125.84
|
|
|
OS PAROXETINE SERUM
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30000059
|
|
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 PAROXETINE SERUM
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30000059
|
|
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 PARSLEY IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000749
|
|
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 PARSLEY IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000749
|
|
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 PARVOVIRUS B19 AB IGG
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
30001199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem Medicaid |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.03
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Humana KY Medicaid |
$15.03
|
| Rate for Payer: Humana Medicare Advantage |
$15.03
|
| Rate for Payer: Kentucky WC Medicaid |
$15.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
OS PARVOVIRUS B19 AB IGG
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
30001199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.63
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
OS PARVOVIRUS B19 AB IGM S
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
30001198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem Medicaid |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.03
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Humana KY Medicaid |
$15.03
|
| Rate for Payer: Humana Medicare Advantage |
$15.03
|
| Rate for Payer: Kentucky WC Medicaid |
$15.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
OS PARVOVIRUS B19 AB IGM S
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
30001198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.63
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
OS PARVOVIRUS B19 PCR
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001399
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$355.20 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.11
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.30
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
|
OS PARVOVIRUS B19 PCR
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001399
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$355.20 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.30
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
|
OS PASSION FRUIT IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000812
|
|
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 PASSION FRUIT IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000812
|
|
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 PATHOLOGY CONSULT
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30001519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$497.28 |
| Rate for Payer: Aetna Commercial |
$398.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$415.95
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$429.94
|
| Rate for Payer: First Health Commercial |
$492.10
|
| Rate for Payer: Humana Commercial |
$440.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$424.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$382.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$455.84
|
| Rate for Payer: Ohio Health Group HMO |
$388.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$357.42
|
| Rate for Payer: PHCS Commercial |
$497.28
|
| Rate for Payer: United Healthcare All Payer |
$455.84
|
|
|
OS PATHOLOGY CONSULT
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30001519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$497.28 |
| Rate for Payer: Aetna Commercial |
$398.86
|
| Rate for Payer: Anthem Medicaid |
$49.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$415.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$69.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.37
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$429.94
|
| Rate for Payer: First Health Commercial |
$492.10
|
| Rate for Payer: Humana Commercial |
$440.30
|
| Rate for Payer: Humana KY Medicaid |
$49.37
|
| Rate for Payer: Humana Medicare Advantage |
$49.37
|
| Rate for Payer: Kentucky WC Medicaid |
$49.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$424.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$382.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$455.84
|
| Rate for Payer: Ohio Health Group HMO |
$388.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$357.42
|
| Rate for Payer: PHCS Commercial |
$497.28
|
| Rate for Payer: United Healthcare All Payer |
$455.84
|
|
|
OS PATH PROCEDURE LEVEL 6
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 81405
|
| Hospital Charge Code |
30001884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.55
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
OS PATH PROCEDURE LEVEL 6
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 81405
|
| Hospital Charge Code |
30001884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$301.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$301.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$421.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.35
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$301.35
|
| Rate for Payer: Humana Medicare Advantage |
$301.35
|
| Rate for Payer: Kentucky WC Medicaid |
$304.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$307.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
OS PATH PROCEDURE LEVEL 7
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 81406
|
| Hospital Charge Code |
30002056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.56
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.11
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
OS PATH PROCEDURE LEVEL 7
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 81406
|
| Hospital Charge Code |
30002056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.11 |
| Max. Negotiated Rate |
$396.03 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$282.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$282.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$396.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$282.88
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$282.88
|
| Rate for Payer: Humana Medicare Advantage |
$282.88
|
| Rate for Payer: Kentucky WC Medicaid |
$285.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$288.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.11
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
OS PATH PROCEDURE LEVEL 8
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
HCPCS 81407
|
| Hospital Charge Code |
30002057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$343.68 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.47
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$297.14
|
| Rate for Payer: First Health Commercial |
$340.10
|
| Rate for Payer: Humana Commercial |
$304.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$293.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.04
|
| Rate for Payer: Ohio Health Group HMO |
$268.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$286.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.02
|
| Rate for Payer: PHCS Commercial |
$343.68
|
| Rate for Payer: United Healthcare All Payer |
$315.04
|
|
|
OS PATH PROCEDURE LEVEL 8
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
HCPCS 81407
|
| Hospital Charge Code |
30002057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$247.02 |
| Max. Negotiated Rate |
$1,184.78 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Anthem Medicaid |
$846.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$846.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,184.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$846.27
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$297.14
|
| Rate for Payer: First Health Commercial |
$340.10
|
| Rate for Payer: Humana Commercial |
$304.30
|
| Rate for Payer: Humana KY Medicaid |
$846.27
|
| Rate for Payer: Humana Medicare Advantage |
$846.27
|
| Rate for Payer: Kentucky WC Medicaid |
$854.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$293.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,015.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$863.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.04
|
| Rate for Payer: Ohio Health Group HMO |
$268.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$286.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.02
|
| Rate for Payer: PHCS Commercial |
$343.68
|
| Rate for Payer: United Healthcare All Payer |
$315.04
|
|
