|
OS SULFATIDE AUTOANTIBODY 1
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000403
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$452.16 |
| Rate for Payer: Aetna Commercial |
$362.67
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$378.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$390.93
|
| Rate for Payer: First Health Commercial |
$447.45
|
| Rate for Payer: Humana Commercial |
$400.35
|
| 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 |
$386.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.48
|
| Rate for Payer: Ohio Health Group HMO |
$353.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.99
|
| Rate for Payer: PHCS Commercial |
$452.16
|
| Rate for Payer: United Healthcare All Payer |
$414.48
|
|
|
OS SULFATIDE AUTOANTIBODY 2
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.30 |
| Max. Negotiated Rate |
$452.16 |
| Rate for Payer: Aetna Commercial |
$362.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$378.21
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$390.93
|
| Rate for Payer: First Health Commercial |
$447.45
|
| Rate for Payer: Humana Commercial |
$400.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$386.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.48
|
| Rate for Payer: Ohio Health Group HMO |
$353.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.99
|
| Rate for Payer: PHCS Commercial |
$452.16
|
| Rate for Payer: United Healthcare All Payer |
$414.48
|
|
|
OS SULFATIDE AUTOANTIBODY 2
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$452.16 |
| Rate for Payer: Aetna Commercial |
$362.67
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$378.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$390.93
|
| Rate for Payer: First Health Commercial |
$447.45
|
| Rate for Payer: Humana Commercial |
$400.35
|
| 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 |
$386.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.48
|
| Rate for Payer: Ohio Health Group HMO |
$353.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.99
|
| Rate for Payer: PHCS Commercial |
$452.16
|
| Rate for Payer: United Healthcare All Payer |
$414.48
|
|
|
OS SUNFLOWER SEED IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000664
|
|
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 SUNFLOWER SEED IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000664
|
|
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 SURG PATHOLOGY CONSULT
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
HCPCS 88325
|
| Hospital Charge Code |
30001520
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$538.56 |
| Rate for Payer: Aetna Commercial |
$431.97
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$450.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$465.63
|
| Rate for Payer: First Health Commercial |
$532.95
|
| Rate for Payer: Humana Commercial |
$476.85
|
| Rate for Payer: Humana KY Medicaid |
$158.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.33
|
| Rate for Payer: Kentucky WC Medicaid |
$159.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.68
|
| Rate for Payer: Ohio Health Group HMO |
$420.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.09
|
| Rate for Payer: PHCS Commercial |
$538.56
|
| Rate for Payer: United Healthcare All Payer |
$493.68
|
|
|
OS SURG PATHOLOGY CONSULT
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
HCPCS 88325
|
| Hospital Charge Code |
30001520
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.30 |
| Max. Negotiated Rate |
$538.56 |
| Rate for Payer: Aetna Commercial |
$431.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$450.48
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$465.63
|
| Rate for Payer: First Health Commercial |
$532.95
|
| Rate for Payer: Humana Commercial |
$476.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.68
|
| Rate for Payer: Ohio Health Group HMO |
$420.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.09
|
| Rate for Payer: PHCS Commercial |
$538.56
|
| Rate for Payer: United Healthcare All Payer |
$493.68
|
|
|
OS SWEET POTATO IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000781
|
|
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 SWEET POTATO IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000781
|
|
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 SWORDFISH IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000741
|
|
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 SWORDFISH IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000741
|
|
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 SYNTHETICS MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80371
|
| Hospital Charge Code |
30000167
|
|
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 SYNTHETICS MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000167
|
|
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 SYNTHETICS MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000167
|
|
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 SYNTHETICS MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80371
|
| Hospital Charge Code |
30000167
|
|
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 SYPHILIS TOTAL AB S
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
30001216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem Medicaid |
$13.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.24
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Humana KY Medicaid |
$13.24
|
| Rate for Payer: Humana Medicare Advantage |
$13.24
|
| Rate for Payer: Kentucky WC Medicaid |
$13.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
OS SYPHILIS TOTAL AB S
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
30001216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
OS T3 TRIIODOTHYRONINE REVER S
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 84482
|
| Hospital Charge Code |
30000544
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.48
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.86
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
OS T3 TRIIODOTHYRONINE REVER S
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 84482
|
| Hospital Charge Code |
30000544
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem Medicaid |
$15.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.76
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Humana KY Medicaid |
$15.76
|
| Rate for Payer: Humana Medicare Advantage |
$15.76
|
| Rate for Payer: Kentucky WC Medicaid |
$15.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.86
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
OS T4 (THYROXINE) FREE S
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
30000527
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$9.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.02
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$9.02
|
| Rate for Payer: Humana Medicare Advantage |
$9.02
|
| Rate for Payer: Kentucky WC Medicaid |
$9.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
OS T4 (THYROXINE) FREE S
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
30000527
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.00
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
OS TACROLIMUS BLOOD
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
30000048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$227.52 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Anthem Medicaid |
$13.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$190.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.73
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$196.71
|
| Rate for Payer: First Health Commercial |
$225.15
|
| Rate for Payer: Humana Commercial |
$201.45
|
| Rate for Payer: Humana KY Medicaid |
$13.73
|
| Rate for Payer: Humana Medicare Advantage |
$13.73
|
| Rate for Payer: Kentucky WC Medicaid |
$13.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$194.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$208.56
|
| Rate for Payer: Ohio Health Group HMO |
$177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.53
|
| Rate for Payer: PHCS Commercial |
$227.52
|
| Rate for Payer: United Healthcare All Payer |
$208.56
|
|
|
OS TACROLIMUS BLOOD
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
30000048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.10 |
| Max. Negotiated Rate |
$227.52 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$190.31
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$196.71
|
| Rate for Payer: First Health Commercial |
$225.15
|
| Rate for Payer: Humana Commercial |
$201.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$194.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$208.56
|
| Rate for Payer: Ohio Health Group HMO |
$177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.53
|
| Rate for Payer: PHCS Commercial |
$227.52
|
| Rate for Payer: United Healthcare All Payer |
$208.56
|
|
|
OS TAPENTADOL
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000170
|
|
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 TAPENTADOL
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80372
|
| Hospital Charge Code |
30000170
|
|
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
|
|
