|
OS CHLAMYDIA IGG 1
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
30001127
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$11.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.82
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$11.82
|
| Rate for Payer: Humana Medicare Advantage |
$11.82
|
| Rate for Payer: Kentucky WC Medicaid |
$11.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
OS CHLAMYDIA IGG 2
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
30001129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$11.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.82
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$11.82
|
| Rate for Payer: Humana Medicare Advantage |
$11.82
|
| Rate for Payer: Kentucky WC Medicaid |
$11.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
OS CHLAMYDIA IGG 2
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
30001129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
OS CHLAMYDIA IGG 3
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
30001128
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$11.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.82
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$11.82
|
| Rate for Payer: Humana Medicare Advantage |
$11.82
|
| Rate for Payer: Kentucky WC Medicaid |
$11.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
OS CHLAMYDIA IGG 3
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
30001128
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
OS CHLAMYDIA IGM 1
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
30001132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
OS CHLAMYDIA IGM 1
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
30001132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$12.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.68
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$12.68
|
| Rate for Payer: Kentucky WC Medicaid |
$12.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
OS CHLAMYDIA IGM 2
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
30001130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
OS CHLAMYDIA IGM 2
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
30001130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$12.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.68
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$12.68
|
| Rate for Payer: Kentucky WC Medicaid |
$12.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
OS CHLAMYDIA IGM 3
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
30001131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
OS CHLAMYDIA IGM 3
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
30001131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$12.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.68
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$12.68
|
| Rate for Payer: Kentucky WC Medicaid |
$12.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
OS CHLORIDE FECES
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
30000279
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.43
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
OS CHLORIDE FECES
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
30000279
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem Medicaid |
$5.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.00
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Humana KY Medicaid |
$5.00
|
| Rate for Payer: Humana Medicare Advantage |
$5.00
|
| Rate for Payer: Kentucky WC Medicaid |
$5.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.43
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
OS CHOLESTEROL
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
30000281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.43
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
OS CHOLESTEROL
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
30000281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem Medicaid |
$4.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.35
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Humana KY Medicaid |
$4.35
|
| Rate for Payer: Humana Medicare Advantage |
$4.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.43
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
OS CHROMO ANALY HEMATO DISORD
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
30001469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem Medicaid |
$144.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$144.61
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Humana KY Medicaid |
$144.61
|
| Rate for Payer: Humana Medicare Advantage |
$144.61
|
| Rate for Payer: Kentucky WC Medicaid |
$146.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.05
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
OS CHROMO ANALY HEMATO DISORD
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
30001467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.89 |
| Max. Negotiated Rate |
$626.88 |
| Rate for Payer: Aetna Commercial |
$502.81
|
| Rate for Payer: Anthem Medicaid |
$125.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$125.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$175.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.49
|
| Rate for Payer: Cash Price |
$326.50
|
| Rate for Payer: Cash Price |
$326.50
|
| Rate for Payer: Cigna Commercial |
$541.99
|
| Rate for Payer: First Health Commercial |
$620.35
|
| Rate for Payer: Humana Commercial |
$555.05
|
| Rate for Payer: Humana KY Medicaid |
$125.49
|
| Rate for Payer: Humana Medicare Advantage |
$125.49
|
| Rate for Payer: Kentucky WC Medicaid |
$126.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$535.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$481.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$574.64
|
| Rate for Payer: Ohio Health Group HMO |
$489.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.43
|
| Rate for Payer: PHCS Commercial |
$626.88
|
| Rate for Payer: United Healthcare All Payer |
$574.64
|
|
|
OS CHROMO ANALY HEMATO DISORD
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
30001469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.26
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.05
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
OS CHROMO ANALY HEMATO DISORD
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
30001467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.89 |
| Max. Negotiated Rate |
$626.88 |
| Rate for Payer: Aetna Commercial |
$502.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.36
|
| Rate for Payer: Cash Price |
$326.50
|
| Rate for Payer: Cigna Commercial |
$541.99
|
| Rate for Payer: First Health Commercial |
$620.35
|
| Rate for Payer: Humana Commercial |
$555.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$535.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$481.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$574.64
|
| Rate for Payer: Ohio Health Group HMO |
$489.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.43
|
| Rate for Payer: PHCS Commercial |
$626.88
|
| Rate for Payer: United Healthcare All Payer |
$574.64
|
|
|
OS CHROMOGRANIN A S
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
30001042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem Medicaid |
$20.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Humana KY Medicaid |
$20.81
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Kentucky WC Medicaid |
$21.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
OS CHROMOGRANIN A S
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
30001042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.83
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
OS Chromosomal Microarray, Blo
|
Facility
|
OP
|
$2,495.00
|
|
|
Service Code
|
HCPCS 81229
|
| Hospital Charge Code |
30001845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$324.35 |
| Max. Negotiated Rate |
$2,395.20 |
| Rate for Payer: Aetna Commercial |
$1,921.15
|
| Rate for Payer: Anthem Medicaid |
$1,160.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,160.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,003.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,624.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,247.50
|
| Rate for Payer: Cash Price |
$1,247.50
|
| Rate for Payer: Cigna Commercial |
$2,070.85
|
| Rate for Payer: First Health Commercial |
$2,370.25
|
| Rate for Payer: Humana Commercial |
$2,120.75
|
| Rate for Payer: Humana KY Medicaid |
$1,160.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,160.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,171.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,045.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,841.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,183.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,195.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,871.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$499.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$324.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$773.45
|
| Rate for Payer: PHCS Commercial |
$2,395.20
|
| Rate for Payer: United Healthcare All Payer |
$2,195.60
|
|
|
OS Chromosomal Microarray, Blo
|
Facility
|
IP
|
$2,495.00
|
|
|
Service Code
|
HCPCS 81229
|
| Hospital Charge Code |
30001845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$324.35 |
| Max. Negotiated Rate |
$2,395.20 |
| Rate for Payer: Aetna Commercial |
$1,921.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,003.48
|
| Rate for Payer: Cash Price |
$1,247.50
|
| Rate for Payer: Cigna Commercial |
$2,070.85
|
| Rate for Payer: First Health Commercial |
$2,370.25
|
| Rate for Payer: Humana Commercial |
$2,120.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,045.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,841.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$748.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,195.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,871.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$499.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$324.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$773.45
|
| Rate for Payer: PHCS Commercial |
$2,395.20
|
| Rate for Payer: United Healthcare All Payer |
$2,195.60
|
|
|
OS CHROMOSOME ADD KERYOTYPE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
30001500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$33.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$33.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$46.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.47
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Humana KY Medicaid |
$33.47
|
| Rate for Payer: Humana Medicare Advantage |
$33.47
|
| Rate for Payer: Kentucky WC Medicaid |
$33.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
OS CHROMOSOME ADD KERYOTYPE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
30001500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
