|
OS VITAMIN B6
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
30000504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$311.56
|
| 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: 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 |
$116.40
|
| 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
|
|
|
OS VITAMIN B7
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
30001820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.77
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.41
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
OS VITAMIN B7
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
30001820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem Medicaid |
$17.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.06
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Humana KY Medicaid |
$17.06
|
| Rate for Payer: Humana Medicare Advantage |
$17.06
|
| Rate for Payer: Kentucky WC Medicaid |
$17.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.41
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
OS VITAMIN E S
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 84446
|
| Hospital Charge Code |
30000533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: Aetna Commercial |
$142.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.56
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: First Health Commercial |
$175.75
|
| Rate for Payer: Humana Commercial |
$157.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.80
|
| Rate for Payer: Ohio Health Group HMO |
$138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.65
|
| Rate for Payer: PHCS Commercial |
$177.60
|
| Rate for Payer: United Healthcare All Payer |
$162.80
|
|
|
OS VITAMIN E S
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 84446
|
| Hospital Charge Code |
30000533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: Aetna Commercial |
$142.45
|
| Rate for Payer: Anthem Medicaid |
$14.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.18
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: First Health Commercial |
$175.75
|
| Rate for Payer: Humana Commercial |
$157.25
|
| Rate for Payer: Humana KY Medicaid |
$14.18
|
| Rate for Payer: Humana Medicare Advantage |
$14.18
|
| Rate for Payer: Kentucky WC Medicaid |
$14.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.80
|
| Rate for Payer: Ohio Health Group HMO |
$138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.65
|
| Rate for Payer: PHCS Commercial |
$177.60
|
| Rate for Payer: United Healthcare All Payer |
$162.80
|
|
|
OS VIT D 125-DIHYDROXY SERU
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
30000305
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$343.68 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Anthem Medicaid |
$38.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$53.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.50
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$297.14
|
| Rate for Payer: First Health Commercial |
$340.10
|
| Rate for Payer: Humana Commercial |
$304.30
|
| Rate for Payer: Humana KY Medicaid |
$38.50
|
| Rate for Payer: Humana Medicare Advantage |
$38.50
|
| Rate for Payer: Kentucky WC Medicaid |
$38.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$293.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.04
|
| Rate for Payer: Ohio Health Group HMO |
$268.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$286.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.02
|
| Rate for Payer: PHCS Commercial |
$343.68
|
| Rate for Payer: United Healthcare All Payer |
$315.04
|
|
|
OS VIT D 125-DIHYDROXY SERU
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
30000305
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$343.68 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.47
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$297.14
|
| Rate for Payer: First Health Commercial |
$340.10
|
| Rate for Payer: Humana Commercial |
$304.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$293.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.04
|
| Rate for Payer: Ohio Health Group HMO |
$268.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$286.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.02
|
| Rate for Payer: PHCS Commercial |
$343.68
|
| Rate for Payer: United Healthcare All Payer |
$315.04
|
|
|
OS VMA URINE
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS 84585
|
| Hospital Charge Code |
30000553
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$170.88 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.93
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cigna Commercial |
$147.74
|
| Rate for Payer: First Health Commercial |
$169.10
|
| Rate for Payer: Humana Commercial |
$151.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$131.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$156.64
|
| Rate for Payer: Ohio Health Group HMO |
$133.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.82
|
| Rate for Payer: PHCS Commercial |
$170.88
|
| Rate for Payer: United Healthcare All Payer |
$156.64
|
|
|
OS VMA URINE
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS 84585
|
| Hospital Charge Code |
30000553
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$170.88 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Anthem Medicaid |
$15.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.50
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cigna Commercial |
$147.74
|
| Rate for Payer: First Health Commercial |
$169.10
|
| Rate for Payer: Humana Commercial |
$151.30
|
| Rate for Payer: Humana KY Medicaid |
$15.50
|
| Rate for Payer: Humana Medicare Advantage |
$15.50
|
| Rate for Payer: Kentucky WC Medicaid |
$15.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$131.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$156.64
|
| Rate for Payer: Ohio Health Group HMO |
$133.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.82
|
| Rate for Payer: PHCS Commercial |
$170.88
|
| Rate for Payer: United Healthcare All Payer |
$156.64
|
|
|
OS VON WILLEBRAND FACTOR AG P
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
30000581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.14
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
OS VON WILLEBRAND FACTOR AG P
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
30000581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem Medicaid |
$22.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.94
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Humana KY Medicaid |
$22.94
|
| Rate for Payer: Humana Medicare Advantage |
$22.94
|
| Rate for Payer: Kentucky WC Medicaid |
$23.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
OS VON WILLEBRAN FACT ACTIVIT
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 85397
|
| Hospital Charge Code |
30000606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.23
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
OS VON WILLEBRAN FACT ACTIVIT
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 85397
|
| Hospital Charge Code |
30000606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem Medicaid |
$30.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$30.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$43.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.86
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Humana KY Medicaid |
$30.86
|
| Rate for Payer: Humana Medicare Advantage |
$30.86
|
| Rate for Payer: Kentucky WC Medicaid |
$31.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
OS VORICONAZOLE
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
HCPCS 80285
|
| Hospital Charge Code |
30001874
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$529.92 |
| Rate for Payer: Aetna Commercial |
$425.04
|
| Rate for Payer: Anthem Medicaid |
$27.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.11
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$458.16
|
| Rate for Payer: First Health Commercial |
$524.40
|
| Rate for Payer: Humana Commercial |
$469.20
|
| Rate for Payer: Humana KY Medicaid |
$27.11
|
| Rate for Payer: Humana Medicare Advantage |
$27.11
|
| Rate for Payer: Kentucky WC Medicaid |
$27.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$452.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$407.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$485.76
|
| Rate for Payer: Ohio Health Group HMO |
$414.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$441.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$480.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.88
|
| Rate for Payer: PHCS Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Payer |
$485.76
|
|
|
OS VORICONAZOLE
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
HCPCS 80285
|
| Hospital Charge Code |
30001874
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$529.92 |
| Rate for Payer: Aetna Commercial |
$425.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.26
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$458.16
|
| Rate for Payer: First Health Commercial |
$524.40
|
| Rate for Payer: Humana Commercial |
$469.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$452.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$407.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$485.76
|
| Rate for Payer: Ohio Health Group HMO |
$414.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$441.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$480.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.88
|
| Rate for Payer: PHCS Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Payer |
$485.76
|
|
|
OS VWF MULTIMER P
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
HCPCS 85247
|
| Hospital Charge Code |
30000582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$290.88 |
| Rate for Payer: Aetna Commercial |
$233.31
|
| Rate for Payer: Anthem Medicaid |
$22.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$243.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.94
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$251.49
|
| Rate for Payer: First Health Commercial |
$287.85
|
| Rate for Payer: Humana Commercial |
$257.55
|
| Rate for Payer: Humana KY Medicaid |
$22.94
|
| Rate for Payer: Humana Medicare Advantage |
$22.94
|
| Rate for Payer: Kentucky WC Medicaid |
$23.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$248.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$223.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$266.64
|
| Rate for Payer: Ohio Health Group HMO |
$227.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$242.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.07
|
| Rate for Payer: PHCS Commercial |
$290.88
|
| Rate for Payer: United Healthcare All Payer |
$266.64
|
|
|
OS VWF MULTIMER P
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
HCPCS 85247
|
| Hospital Charge Code |
30000582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$290.88 |
| Rate for Payer: Aetna Commercial |
$233.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$243.31
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$251.49
|
| Rate for Payer: First Health Commercial |
$287.85
|
| Rate for Payer: Humana Commercial |
$257.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$248.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$223.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$266.64
|
| Rate for Payer: Ohio Health Group HMO |
$227.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$242.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.07
|
| Rate for Payer: PHCS Commercial |
$290.88
|
| Rate for Payer: United Healthcare All Payer |
$266.64
|
|
|
OS VZV IGG OR IGM AB S
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
30001218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.74
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
OS VZV IGG OR IGM AB S
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
30001218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem Medicaid |
$12.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Humana KY Medicaid |
$12.88
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Kentucky WC Medicaid |
$13.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
OS WASP VENOM IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000793
|
|
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 WASP VENOM IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000793
|
|
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 WEED PANEL 1 IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000791
|
|
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 WEED PANEL 1 IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000791
|
|
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 WEED PANEL 2 IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000684
|
|
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 WEED PANEL 2 IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000684
|
|
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
|
|
