|
OS VARICELL ZOSTER VIR BY PCR
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001397
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
OS VARICELL ZOSTER VIR BY PCR
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001397
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.68
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
OS VASOACTI INTESTINA POLYPEP
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
30000554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.33 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem Medicaid |
$35.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.33
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Humana KY Medicaid |
$35.33
|
| Rate for Payer: Humana Medicare Advantage |
$35.33
|
| Rate for Payer: Kentucky WC Medicaid |
$35.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
OS VASOACTI INTESTINA POLYPEP
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
30000554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
OS VCA IGG
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$18.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.14
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$18.14
|
| Rate for Payer: Humana Medicare Advantage |
$18.14
|
| Rate for Payer: Kentucky WC Medicaid |
$18.32
|
| 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 |
$21.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.50
|
| 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 VCA IGG
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001155
|
|
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
|
|
|
OS VCA IGG
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$14.12
|
| Rate for Payer: Ambetter Exchange |
$18.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$18.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.77
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$16.06
|
| Rate for Payer: Healthspan PPO |
$14.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$18.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.14
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$23.58
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.14
|
|
|
OS VCA IGM
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$14.12
|
| Rate for Payer: Ambetter Exchange |
$18.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$18.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.77
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$16.06
|
| Rate for Payer: Healthspan PPO |
$14.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$18.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.14
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$23.58
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.14
|
|
|
OS VCA IGM
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001153
|
|
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
|
|
|
OS VCA IGM
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$18.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.14
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$18.14
|
| Rate for Payer: Humana Medicare Advantage |
$18.14
|
| Rate for Payer: Kentucky WC Medicaid |
$18.32
|
| 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 |
$21.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.50
|
| 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 VCAM
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000272
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$14.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.12
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Humana KY Medicaid |
$14.12
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$14.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS VCAM
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000272
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS VDRL CSF
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS VDRL CSF
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS Vectra
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 81490
|
| Hospital Charge Code |
30002077
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$672.75 |
| Max. Negotiated Rate |
$1,176.91 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$840.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$840.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$782.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,176.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$840.65
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$840.65
|
| Rate for Payer: Humana Medicare Advantage |
$840.65
|
| Rate for Payer: Kentucky WC Medicaid |
$849.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,008.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$857.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
OS Vectra
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 81490
|
| Hospital Charge Code |
30002077
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$782.92
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
OS VEGF
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000276
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
OS VEGF
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000276
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$14.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.12
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Humana KY Medicaid |
$14.12
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$14.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
OS VELVET LEAF GRASS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000667
|
|
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 VELVET LEAF GRASS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000667
|
|
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 VISCOSITY S
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 85810
|
| Hospital Charge Code |
30000634
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
OS VISCOSITY S
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 85810
|
| Hospital Charge Code |
30000634
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$11.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.67
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$11.67
|
| Rate for Payer: Humana Medicare Advantage |
$11.67
|
| Rate for Payer: Kentucky WC Medicaid |
$11.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
OS VITAMIN A S
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
30000556
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$189.12 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.19
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.93
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
OS VITAMIN A S
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
30000556
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$189.12 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem Medicaid |
$11.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.61
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Humana KY Medicaid |
$11.61
|
| Rate for Payer: Humana Medicare Advantage |
$11.61
|
| Rate for Payer: Kentucky WC Medicaid |
$11.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.93
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
OS VITAMIN B6
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
30000504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem Medicaid |
$28.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$311.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.10
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Humana KY Medicaid |
$28.10
|
| Rate for Payer: Humana Medicare Advantage |
$28.10
|
| Rate for Payer: Kentucky WC Medicaid |
$28.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
