|
OS RAT EPITHELIUM IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000807
|
|
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 RENIN ACTIVITY
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
30000506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$21.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.99
|
| 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 |
$21.99
|
| Rate for Payer: Humana Medicare Advantage |
$21.99
|
| Rate for Payer: Kentucky WC Medicaid |
$22.21
|
| 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 |
$26.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.43
|
| 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
|
|
|
OS RENIN ACTIVITY
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
30000506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| 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: 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 |
$65.40
|
| 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
|
|
|
OS REPTILASE TIME
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 85635
|
| Hospital Charge Code |
30000624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem Medicaid |
$9.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.85
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Humana KY Medicaid |
$9.85
|
| Rate for Payer: Humana Medicare Advantage |
$9.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.19
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
OS REPTILASE TIME
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 85635
|
| Hospital Charge Code |
30000624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.19
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
OS RESPIR SYNCYTIAL VIR IGG
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86756
|
| Hospital Charge Code |
30001204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$15.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.89
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$15.89
|
| Rate for Payer: Humana Medicare Advantage |
$15.89
|
| Rate for Payer: Kentucky WC Medicaid |
$16.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.52
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS RESPIR SYNCYTIAL VIR IGG
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86756
|
| Hospital Charge Code |
30001204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.52
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS RESPIR SYNCYTIAL VIR IGM
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86756
|
| Hospital Charge Code |
30001203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$15.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.89
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$15.89
|
| Rate for Payer: Humana Medicare Advantage |
$15.89
|
| Rate for Payer: Kentucky WC Medicaid |
$16.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.52
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS RESPIR SYNCYTIAL VIR IGM
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86756
|
| Hospital Charge Code |
30001203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.52
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS RETICULIN ABS S
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Ambetter Exchange |
$12.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.46
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$22.62
|
| Rate for Payer: Healthspan PPO |
$12.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.05
|
| Rate for Payer: Multiplan PHCS |
$93.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$15.66
|
| Rate for Payer: UHCCP Medicaid |
$54.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
|
|
OS RETICULIN ABS S
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.64
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS RETICULIN ABS S
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| 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 |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.64
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS RHEUMATOID FACTOR IGA
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.53
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
OS RHEUMATOID FACTOR IGA
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$5.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.67
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| 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 |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
OS RHEUMATOID FACTOR IGM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.53
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
OS RHEUMATOID FACTOR IGM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$5.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.67
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| 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 |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
OS RIBOFLAVIN VITAMIN B2 P
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
30000507
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.66
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.34
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
OS RIBOFLAVIN VITAMIN B2 P
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
30000507
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem Medicaid |
$20.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.24
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Humana KY Medicaid |
$20.24
|
| Rate for Payer: Humana Medicare Advantage |
$20.24
|
| Rate for Payer: Kentucky WC Medicaid |
$20.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.34
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
OS RIBOSOME P AB IGG S
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000416
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
OS RIBOSOME P AB IGG S
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000416
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| 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 |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
OS RICE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000848
|
|
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 RICE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000848
|
|
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 RISTOCETIN COFACTOR PLASMA
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
30000580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: Aetna Commercial |
$177.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$185.49
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$191.73
|
| Rate for Payer: First Health Commercial |
$219.45
|
| Rate for Payer: Humana Commercial |
$196.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$189.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$170.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$203.28
|
| Rate for Payer: Ohio Health Group HMO |
$173.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.39
|
| Rate for Payer: PHCS Commercial |
$221.76
|
| Rate for Payer: United Healthcare All Payer |
$203.28
|
|
|
OS RISTOCETIN COFACTOR PLASMA
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
30000580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: Aetna Commercial |
$177.87
|
| Rate for Payer: Anthem Medicaid |
$22.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$185.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.94
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$191.73
|
| Rate for Payer: First Health Commercial |
$219.45
|
| Rate for Payer: Humana Commercial |
$196.35
|
| Rate for Payer: Humana KY Medicaid |
$22.94
|
| Rate for Payer: Humana Medicare Advantage |
$22.94
|
| Rate for Payer: Kentucky WC Medicaid |
$23.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$189.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$170.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$203.28
|
| Rate for Payer: Ohio Health Group HMO |
$173.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.39
|
| Rate for Payer: PHCS Commercial |
$221.76
|
| Rate for Payer: United Healthcare All Payer |
$203.28
|
|
|
OS ROCKY MTN SPOT FEVER AB IGG
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
30001207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
