|
OS PHENOBARBITAL
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 80184
|
| Hospital Charge Code |
30000041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$15.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.30
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$15.30
|
| Rate for Payer: Humana Medicare Advantage |
$15.30
|
| Rate for Payer: Kentucky WC Medicaid |
$15.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.89
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
OS PHENOBARBITAL
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 80184
|
| Hospital Charge Code |
30000041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.89
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
OS PHENYTOIN FREE DILANTIN
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 80186
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem Medicaid |
$13.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.76
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Humana KY Medicaid |
$13.76
|
| Rate for Payer: Humana Medicare Advantage |
$13.76
|
| Rate for Payer: Kentucky WC Medicaid |
$13.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.54
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS PHENYTOIN FREE DILANTIN
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 80186
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.54
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS PHENYTOIN TOTAL DILANTIN
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 80185
|
| Hospital Charge Code |
30000042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.88
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
OS PHENYTOIN TOTAL DILANTIN
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 80185
|
| Hospital Charge Code |
30000042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.88
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
OS Phosphatidylethanol (PEth)
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 80321
|
| Hospital Charge Code |
30001851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$44.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$44.71
|
| Rate for Payer: Kentucky WC Medicaid |
$45.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
OS Phosphatidylethanol (PEth)
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| 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 |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
OS Phosphatidylethanol (PEth)
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
OS Phosphatidylethanol (PEth)
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 80321
|
| Hospital Charge Code |
30001851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
OS Phospholi A2 Recep ELISA, S
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$322.56 |
| Rate for Payer: Aetna Commercial |
$258.72
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$278.88
|
| Rate for Payer: First Health Commercial |
$319.20
|
| Rate for Payer: Humana Commercial |
$285.60
|
| 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 |
$275.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$295.68
|
| Rate for Payer: Ohio Health Group HMO |
$252.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.84
|
| Rate for Payer: PHCS Commercial |
$322.56
|
| Rate for Payer: United Healthcare All Payer |
$295.68
|
|
|
OS Phospholi A2 Recep ELISA, S
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$322.56 |
| Rate for Payer: Aetna Commercial |
$258.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.81
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$278.88
|
| Rate for Payer: First Health Commercial |
$319.20
|
| Rate for Payer: Humana Commercial |
$285.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$275.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$295.68
|
| Rate for Payer: Ohio Health Group HMO |
$252.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.84
|
| Rate for Payer: PHCS Commercial |
$322.56
|
| Rate for Payer: United Healthcare All Payer |
$295.68
|
|
|
OS Phospholip A2 Recept IFA, S
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30001905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$462.72 |
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$387.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.58
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
|
|
OS Phospholip A2 Recept IFA, S
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30001905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.60 |
| Max. Negotiated Rate |
$462.72 |
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$387.05
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.58
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
|
|
OS PHTHALIC ANHYDRIDE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000829
|
|
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 PHTHALIC ANHYDRIDE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000829
|
|
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 PIGEON FEATHERS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000795
|
|
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 PIGEON FEATHERS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000795
|
|
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 PIG EPITHELIUM IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000765
|
|
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 PIG EPITHELIUM IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000765
|
|
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 PITYROSPORUM ORBICULARIGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000913
|
|
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 PITYROSPORUM ORBICULARIGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000913
|
|
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 PLAICE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000805
|
|
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 PLAICE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000805
|
|
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 PLASMINOGEN ACTIVITY
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 85420
|
| Hospital Charge Code |
30000607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$6.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$6.53
|
| Rate for Payer: Humana Medicare Advantage |
$6.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
