|
OS PT SUBST PLASMA FRAC EA
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
30000622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.76
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.95
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
OS PYRUVATE KINASE RBC
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 84220
|
| Hospital Charge Code |
30000505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.63
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
OS PYRUVATE KINASE RBC
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 84220
|
| Hospital Charge Code |
30000505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem Medicaid |
$9.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.44
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Humana KY Medicaid |
$9.44
|
| Rate for Payer: Humana Medicare Advantage |
$9.44
|
| Rate for Payer: Kentucky WC Medicaid |
$9.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
OS Q FEVER AB IGG
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
30001136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem Medicaid |
$12.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Humana KY Medicaid |
$12.12
|
| Rate for Payer: Humana Medicare Advantage |
$12.12
|
| Rate for Payer: Kentucky WC Medicaid |
$12.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
OS Q FEVER AB IGG
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
30001136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.41
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
OS Q FEVER AB IGM
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
30001138
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.19
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
OS Q FEVER AB IGM
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
30001138
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$12.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$12.12
|
| Rate for Payer: Humana Medicare Advantage |
$12.12
|
| Rate for Payer: Kentucky WC Medicaid |
$12.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
OS Q FEVER PHASE II IGG
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
30001137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.19
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
OS Q FEVER PHASE II IGG
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
30001137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$12.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$12.12
|
| Rate for Payer: Humana Medicare Advantage |
$12.12
|
| Rate for Payer: Kentucky WC Medicaid |
$12.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
OS Q FEVER PHASE II IGM
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
30001139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$12.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$12.12
|
| Rate for Payer: Humana Medicare Advantage |
$12.12
|
| Rate for Payer: Kentucky WC Medicaid |
$12.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
OS Q FEVER PHASE II IGM
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
30001139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.19
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
OS QUINIDINE PLASMA
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 80194
|
| Hospital Charge Code |
30000046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.80
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
OS QUINIDINE PLASMA
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 80194
|
| Hospital Charge Code |
30000046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem Medicaid |
$14.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.60
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Humana KY Medicaid |
$14.60
|
| Rate for Payer: Humana Medicare Advantage |
$14.60
|
| Rate for Payer: Kentucky WC Medicaid |
$14.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
OS RABBIT EPITHELIUM IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000894
|
|
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 RABBIT EPITHELIUM IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000894
|
|
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 RA BODY FLUID
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.81
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS RA BODY FLUID
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem Medicaid |
$5.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.67
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Humana KY Medicaid |
$5.67
|
| Rate for Payer: Humana Medicare Advantage |
$5.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.81
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OSRAPAMYCIN (SIROLIMUS) BLD
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 80195
|
| Hospital Charge Code |
30000047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Ambetter Exchange |
$13.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$12.23
|
| Rate for Payer: Healthspan PPO |
$14.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.73
|
| Rate for Payer: Multiplan PHCS |
$116.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.85
|
| Rate for Payer: UHCCP Medicaid |
$67.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.73
|
|
|
OSRAPAMYCIN (SIROLIMUS) BLD
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 80195
|
| Hospital Charge Code |
30000047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$13.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.73
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Humana KY Medicaid |
$13.73
|
| Rate for Payer: Humana Medicare Advantage |
$13.73
|
| Rate for Payer: Kentucky WC Medicaid |
$13.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.86
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
OSRAPAMYCIN (SIROLIMUS) BLD
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 80195
|
| Hospital Charge Code |
30000047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.86
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
OS RAPE SEED IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000694
|
|
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 RAPE SEED IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000694
|
|
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 RAPID PLASMA REAGIN S
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.18
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
OS RAPID PLASMA REAGIN S
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
OS RAT EPITHELIUM IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000807
|
|
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
|
|
