|
OS SOMA CYCLOBENZAPRINE MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000165
|
|
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 SOMA CYCLOBENZAPRINE MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80369
|
| Hospital Charge Code |
30000165
|
|
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 SOMA CYCLOBENZAPRINE MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000165
|
|
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 SPECIAL CONSULT
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 85390
|
| Hospital Charge Code |
30000605
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.24
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$175.96
|
| Rate for Payer: First Health Commercial |
$201.40
|
| Rate for Payer: Humana Commercial |
$180.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.56
|
| Rate for Payer: Ohio Health Group HMO |
$159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$169.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.28
|
| Rate for Payer: PHCS Commercial |
$203.52
|
| Rate for Payer: United Healthcare All Payer |
$186.56
|
|
|
OS SPECIAL CONSULT
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 85390
|
| Hospital Charge Code |
30000605
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Anthem Medicaid |
$15.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.48
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$175.96
|
| Rate for Payer: First Health Commercial |
$201.40
|
| Rate for Payer: Humana Commercial |
$180.20
|
| Rate for Payer: Humana KY Medicaid |
$15.48
|
| Rate for Payer: Humana Medicare Advantage |
$15.48
|
| Rate for Payer: Kentucky WC Medicaid |
$15.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.56
|
| Rate for Payer: Ohio Health Group HMO |
$159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$169.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.28
|
| Rate for Payer: PHCS Commercial |
$203.52
|
| Rate for Payer: United Healthcare All Payer |
$186.56
|
|
|
OS SPECIAL STAIN
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30001514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$200.70 |
| Max. Negotiated Rate |
$642.24 |
| Rate for Payer: Aetna Commercial |
$515.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$537.21
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$555.27
|
| Rate for Payer: First Health Commercial |
$635.55
|
| Rate for Payer: Humana Commercial |
$568.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$548.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$493.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$588.72
|
| Rate for Payer: Ohio Health Group HMO |
$501.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$535.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.61
|
| Rate for Payer: PHCS Commercial |
$642.24
|
| Rate for Payer: United Healthcare All Payer |
$588.72
|
|
|
OS SPECIAL STAIN
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30001514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$642.24 |
| Rate for Payer: Aetna Commercial |
$515.13
|
| Rate for Payer: Anthem Medicaid |
$119.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$537.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.10
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$555.27
|
| Rate for Payer: First Health Commercial |
$635.55
|
| Rate for Payer: Humana Commercial |
$568.65
|
| Rate for Payer: Humana KY Medicaid |
$119.10
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$120.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$548.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$493.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$588.72
|
| Rate for Payer: Ohio Health Group HMO |
$501.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$535.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.61
|
| Rate for Payer: PHCS Commercial |
$642.24
|
| Rate for Payer: United Healthcare All Payer |
$588.72
|
|
|
OS SPECIAL STAINS GROUP 1
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
30001849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem Medicaid |
$49.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$69.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.37
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Humana KY Medicaid |
$49.37
|
| Rate for Payer: Humana Medicare Advantage |
$49.37
|
| Rate for Payer: Kentucky WC Medicaid |
$49.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.04
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
|
OS SPECIAL STAINS GROUP 1
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
30001849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.45
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.04
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
|
OS SPERM ANTIBODY TEST
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 89325
|
| Hospital Charge Code |
30001844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.55
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
OS SPERM ANTIBODY TEST
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 89325
|
| Hospital Charge Code |
30001844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem Medicaid |
$10.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.67
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Humana KY Medicaid |
$10.67
|
| Rate for Payer: Humana Medicare Advantage |
$10.67
|
| Rate for Payer: Kentucky WC Medicaid |
$10.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.55
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
OS SPINE MUSC ATRO SMA CARRIER
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
HCPCS 81329
|
| Hospital Charge Code |
30000195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$315.84 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Anthem Medicaid |
$137.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$191.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.00
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$273.07
|
| Rate for Payer: First Health Commercial |
$312.55
|
| Rate for Payer: Humana Commercial |
$279.65
|
| Rate for Payer: Humana KY Medicaid |
$137.00
|
| Rate for Payer: Humana Medicare Advantage |
$137.00
|
| Rate for Payer: Kentucky WC Medicaid |
$138.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$269.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$242.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$289.52
|
| Rate for Payer: Ohio Health Group HMO |
$246.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$263.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.01
|
| Rate for Payer: PHCS Commercial |
$315.84
|
| Rate for Payer: United Healthcare All Payer |
$289.52
|
|
|
OS SPINE MUSC ATRO SMA CARRIER
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
HCPCS 81329
|
| Hospital Charge Code |
30000195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$315.84 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.19
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$273.07
|
| Rate for Payer: First Health Commercial |
$312.55
|
| Rate for Payer: Humana Commercial |
$279.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$269.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$242.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$289.52
|
| Rate for Payer: Ohio Health Group HMO |
$246.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$263.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.01
|
| Rate for Payer: PHCS Commercial |
$315.84
|
| Rate for Payer: United Healthcare All Payer |
$289.52
|
|
|
OS SPRUCE TREE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000852
|
|
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 SPRUCE TREE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000852
|
|
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 SQUASH IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000838
|
|
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 SQUASH IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000838
|
|
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 ST2
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 83006
|
| Hospital Charge Code |
30000356
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem Medicaid |
$75.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$75.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$105.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$75.60
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Humana KY Medicaid |
$75.60
|
| Rate for Payer: Humana Medicare Advantage |
$75.60
|
| Rate for Payer: Kentucky WC Medicaid |
$76.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.40
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
OS ST2
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 83006
|
| Hospital Charge Code |
30000356
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.78
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.40
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
OS STACLOT LA P
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 85598
|
| Hospital Charge Code |
30000617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$254.87
|
| Rate for Payer: Anthem Medicaid |
$17.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.98
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$274.73
|
| Rate for Payer: First Health Commercial |
$314.45
|
| Rate for Payer: Humana Commercial |
$281.35
|
| Rate for Payer: Humana KY Medicaid |
$17.98
|
| Rate for Payer: Humana Medicare Advantage |
$17.98
|
| Rate for Payer: Kentucky WC Medicaid |
$18.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$271.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$244.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$291.28
|
| Rate for Payer: Ohio Health Group HMO |
$248.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.39
|
| Rate for Payer: PHCS Commercial |
$317.76
|
| Rate for Payer: United Healthcare All Payer |
$291.28
|
|
|
OS STACLOT LA P
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 85598
|
| Hospital Charge Code |
30000617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$254.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.79
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$274.73
|
| Rate for Payer: First Health Commercial |
$314.45
|
| Rate for Payer: Humana Commercial |
$281.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$271.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$244.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$291.28
|
| Rate for Payer: Ohio Health Group HMO |
$248.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.39
|
| Rate for Payer: PHCS Commercial |
$317.76
|
| Rate for Payer: United Healthcare All Payer |
$291.28
|
|
|
OS STAT3 SNP
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.09
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS STAT3 SNP
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$55.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Humana KY Medicaid |
$55.37
|
| Rate for Payer: Kentucky WC Medicaid |
$55.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.09
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS STEREO ANAL, SINGLE DRG
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 80374
|
| Hospital Charge Code |
30001899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$30.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$30.95
|
| Rate for Payer: Kentucky WC Medicaid |
$31.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
OS STEREO ANAL, SINGLE DRG
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
