|
OS SARS-COV2 COVID-19 ANTIBODY
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
30001788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem Medicaid |
$42.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$58.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.13
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Humana KY Medicaid |
$42.13
|
| Rate for Payer: Humana Medicare Advantage |
$42.13
|
| Rate for Payer: Kentucky WC Medicaid |
$42.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.28
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
OS SARS-COV2 COVID-19 ANTIBODY
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
30001788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.94
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.28
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
OS SCALE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000800
|
|
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 SCALE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000800
|
|
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 SCANNABINOL NAT
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 80349
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$67.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$67.06
|
| Rate for Payer: Kentucky WC Medicaid |
$67.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS SCANNABINOL NAT
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 80349
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS SCANNABINOL NAT
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| 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 |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS SCANNABINOL NAT
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS SCL 70 AUTOANTIBODY
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
30001004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.42
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
OS SCL 70 AUTOANTIBODY
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
30001004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$17.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$17.93
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Kentucky WC Medicaid |
$18.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
OS SEDATIVE HYPNOTICS URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80368
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$8.94
|
| Rate for Payer: Kentucky WC Medicaid |
$9.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS SEDATIVE HYPNOTICS URINE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80368
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Multiplan PHCS |
$15.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.20
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
|
|
OS SEDATIVE HYPNOTICS URINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS SEDATIVE HYPNOTICS URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS SEDATIVE HYPNOTICS URINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80368
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS SELENIUM S
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 84255
|
| Hospital Charge Code |
30000508
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem Medicaid |
$25.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.53
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Humana KY Medicaid |
$25.53
|
| Rate for Payer: Humana Medicare Advantage |
$25.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
OS SELENIUM S
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 84255
|
| Hospital Charge Code |
30000508
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
OS SEROQUEL
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.39 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| 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 |
$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 |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| 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 SEROQUEL
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 80342
|
| Hospital Charge Code |
30000104
|
|
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 Medicaid |
$45.05
|
| 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: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| 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: Molina Healthcare Medicaid |
$45.95
|
| 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 SEROQUEL
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000104
|
|
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 SEROQUEL
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 80342
|
| Hospital Charge Code |
30000104
|
|
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 SEROTONIN
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
30000509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.95
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
OS SEROTONIN
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
30000509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem Medicaid |
$30.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$30.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$43.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.98
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Humana KY Medicaid |
$30.98
|
| Rate for Payer: Humana Medicare Advantage |
$30.98
|
| Rate for Payer: Kentucky WC Medicaid |
$31.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
OS SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
30000973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$469.44 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.67
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$405.87
|
| Rate for Payer: First Health Commercial |
$464.55
|
| Rate for Payer: Humana Commercial |
$415.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.32
|
| Rate for Payer: Ohio Health Group HMO |
$366.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$391.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.41
|
| Rate for Payer: PHCS Commercial |
$469.44
|
| Rate for Payer: United Healthcare All Payer |
$430.32
|
|
|
OS SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
30000973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$469.44 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Anthem Medicaid |
$18.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.37
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$405.87
|
| Rate for Payer: First Health Commercial |
$464.55
|
| Rate for Payer: Humana Commercial |
$415.65
|
| Rate for Payer: Humana KY Medicaid |
$18.37
|
| Rate for Payer: Humana Medicare Advantage |
$18.37
|
| Rate for Payer: Kentucky WC Medicaid |
$18.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.32
|
| Rate for Payer: Ohio Health Group HMO |
$366.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$391.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.41
|
| Rate for Payer: PHCS Commercial |
$469.44
|
| Rate for Payer: United Healthcare All Payer |
$430.32
|
|
