|
OS CHROMOSOME ANALYSIS 5
|
Facility
|
IP
|
$357.75
|
|
|
Service Code
|
HCPCS 88261
|
| Hospital Charge Code |
30002013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$343.44 |
| Rate for Payer: Aetna Commercial |
$275.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.27
|
| Rate for Payer: Cash Price |
$178.88
|
| Rate for Payer: Cigna Commercial |
$296.93
|
| Rate for Payer: First Health Commercial |
$339.86
|
| Rate for Payer: Humana Commercial |
$304.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$293.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$314.82
|
| Rate for Payer: Ohio Health Group HMO |
$268.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.90
|
| Rate for Payer: PHCS Commercial |
$343.44
|
| Rate for Payer: United Healthcare All Payer |
$314.82
|
|
|
OS CHROMOSOME ANALYSIS 5
|
Facility
|
OP
|
$357.75
|
|
|
Service Code
|
HCPCS 88261
|
| Hospital Charge Code |
30002013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$370.08 |
| Rate for Payer: Aetna Commercial |
$275.47
|
| Rate for Payer: Anthem Medicaid |
$264.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$264.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$370.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.34
|
| Rate for Payer: Cash Price |
$178.88
|
| Rate for Payer: Cash Price |
$178.88
|
| Rate for Payer: Cigna Commercial |
$296.93
|
| Rate for Payer: First Health Commercial |
$339.86
|
| Rate for Payer: Humana Commercial |
$304.09
|
| Rate for Payer: Humana KY Medicaid |
$264.34
|
| Rate for Payer: Humana Medicare Advantage |
$264.34
|
| Rate for Payer: Kentucky WC Medicaid |
$266.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$293.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$314.82
|
| Rate for Payer: Ohio Health Group HMO |
$268.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.90
|
| Rate for Payer: PHCS Commercial |
$343.44
|
| Rate for Payer: United Healthcare All Payer |
$314.82
|
|
|
OS CHROMOSOME COUNT ADDITIONAL
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 88285
|
| Hospital Charge Code |
30002014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.14
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.95
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
OS CHROMOSOME COUNT ADDITIONAL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 88285
|
| Hospital Charge Code |
30002014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$26.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.91
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$26.91
|
| Rate for Payer: Humana Medicare Advantage |
$26.91
|
| Rate for Payer: Kentucky WC Medicaid |
$27.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.95
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
OS CHROMSM INSITU HYBRDZATIO
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 88273
|
| Hospital Charge Code |
30001488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.79 |
| Max. Negotiated Rate |
$271.68 |
| Rate for Payer: Aetna Commercial |
$217.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.25
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$234.89
|
| Rate for Payer: First Health Commercial |
$268.85
|
| Rate for Payer: Humana Commercial |
$240.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.04
|
| Rate for Payer: Ohio Health Group HMO |
$212.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.73
|
| Rate for Payer: PHCS Commercial |
$271.68
|
| Rate for Payer: United Healthcare All Payer |
$249.04
|
|
|
OS CHROMSM INSITU HYBRDZATIO
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 88273
|
| Hospital Charge Code |
30001488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$271.68 |
| Rate for Payer: Aetna Commercial |
$217.91
|
| Rate for Payer: Anthem Medicaid |
$34.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.81
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$234.89
|
| Rate for Payer: First Health Commercial |
$268.85
|
| Rate for Payer: Humana Commercial |
$240.55
|
| Rate for Payer: Humana KY Medicaid |
$34.81
|
| Rate for Payer: Humana Medicare Advantage |
$34.81
|
| Rate for Payer: Kentucky WC Medicaid |
$35.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.04
|
| Rate for Payer: Ohio Health Group HMO |
$212.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.73
|
| Rate for Payer: PHCS Commercial |
$271.68
|
| Rate for Payer: United Healthcare All Payer |
$249.04
|
|
|
OS CHROMSOM ANAL AMNOTIC FL
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
HCPCS 88269
|
| Hospital Charge Code |
30001470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.48 |
| Max. Negotiated Rate |
$668.16 |
| Rate for Payer: Aetna Commercial |
$535.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$558.89
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$577.68
|
| Rate for Payer: First Health Commercial |
$661.20
|
| Rate for Payer: Humana Commercial |
$591.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$570.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$513.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$612.48
|
| Rate for Payer: Ohio Health Group HMO |
$522.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.76
|
| Rate for Payer: PHCS Commercial |
$668.16
|
| Rate for Payer: United Healthcare All Payer |
$612.48
|
|
|
OS CHROMSOM ANAL AMNOTIC FL
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
HCPCS 88269
|
| Hospital Charge Code |
30001470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.48 |
| Max. Negotiated Rate |
$668.16 |
| Rate for Payer: Aetna Commercial |
$535.92
|
| Rate for Payer: Anthem Medicaid |
$173.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$558.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$243.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$173.66
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$577.68
|
| Rate for Payer: First Health Commercial |
$661.20
|
| Rate for Payer: Humana Commercial |
$591.60
|
| Rate for Payer: Humana KY Medicaid |
$173.66
|
| Rate for Payer: Humana Medicare Advantage |
$173.66
|
| Rate for Payer: Kentucky WC Medicaid |
$175.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$570.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$513.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$612.48
|
| Rate for Payer: Ohio Health Group HMO |
$522.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.76
|
| Rate for Payer: PHCS Commercial |
$668.16
|
| Rate for Payer: United Healthcare All Payer |
$612.48
|
|
|
OS CINNAMON IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| 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 |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS CINNAMON IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS CITRATE EXCRETION URINE
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
30000284
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$314.88 |
| Rate for Payer: Aetna Commercial |
$252.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.38
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna Commercial |
$272.24
|
| Rate for Payer: First Health Commercial |
$311.60
|
| Rate for Payer: Humana Commercial |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$242.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$288.64
|
| Rate for Payer: Ohio Health Group HMO |
$246.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.68
|
| Rate for Payer: PHCS Commercial |
$314.88
|
| Rate for Payer: United Healthcare All Payer |
$288.64
|
|
|
OS CITRATE EXCRETION URINE
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
30000284
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$314.88 |
| Rate for Payer: Aetna Commercial |
$252.56
|
| Rate for Payer: Anthem Medicaid |
$27.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.80
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna Commercial |
$272.24
|
| Rate for Payer: First Health Commercial |
$311.60
|
| Rate for Payer: Humana Commercial |
$278.80
|
| Rate for Payer: Humana KY Medicaid |
$27.80
|
| Rate for Payer: Humana Medicare Advantage |
$27.80
|
| Rate for Payer: Kentucky WC Medicaid |
$28.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$242.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$288.64
|
| Rate for Payer: Ohio Health Group HMO |
$246.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.68
|
| Rate for Payer: PHCS Commercial |
$314.88
|
| Rate for Payer: United Healthcare All Payer |
$288.64
|
|
|
OS CK TOTAL
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
30000293
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem Medicaid |
$13.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Humana KY Medicaid |
$13.39
|
| Rate for Payer: Humana Medicare Advantage |
$13.39
|
| Rate for Payer: Kentucky WC Medicaid |
$13.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS CK TOTAL
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
30000293
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS CLADOSPORIUM HERBARIUM IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000725
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS CLADOSPORIUM HERBARIUM IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000725
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| 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 |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS CLONAZEPAM S
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.42
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
OS CLONAZEPAM S
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
OS CLOT INHIBIT PROT C ACIV
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
30000592
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$298.56 |
| Rate for Payer: Aetna Commercial |
$239.47
|
| Rate for Payer: Anthem Medicaid |
$13.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.84
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$258.13
|
| Rate for Payer: First Health Commercial |
$295.45
|
| Rate for Payer: Humana Commercial |
$264.35
|
| Rate for Payer: Humana KY Medicaid |
$13.84
|
| Rate for Payer: Humana Medicare Advantage |
$13.84
|
| Rate for Payer: Kentucky WC Medicaid |
$13.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$255.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$229.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$273.68
|
| Rate for Payer: Ohio Health Group HMO |
$233.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.41
|
| Rate for Payer: PHCS Commercial |
$298.56
|
| Rate for Payer: United Healthcare All Payer |
$273.68
|
|
|
OS CLOT INHIBIT PROT C ACIV
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
30000592
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$298.56 |
| Rate for Payer: Aetna Commercial |
$239.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.73
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$258.13
|
| Rate for Payer: First Health Commercial |
$295.45
|
| Rate for Payer: Humana Commercial |
$264.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$255.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$229.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$273.68
|
| Rate for Payer: Ohio Health Group HMO |
$233.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.41
|
| Rate for Payer: PHCS Commercial |
$298.56
|
| Rate for Payer: United Healthcare All Payer |
$273.68
|
|
|
OS CLOVE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS CLOVE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| 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 |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS CLOZAPINE S
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 80159
|
| Hospital Charge Code |
30000024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.18
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
OS CLOZAPINE S
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 80159
|
| Hospital Charge Code |
30000024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.15
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Humana KY Medicaid |
$20.15
|
| Rate for Payer: Humana Medicare Advantage |
$20.15
|
| Rate for Payer: Kentucky WC Medicaid |
$20.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
OS CMV DNA DETECT/QUANT P
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
30001370
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna Commercial |
$438.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$457.71
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$473.10
|
| Rate for Payer: First Health Commercial |
$541.50
|
| Rate for Payer: Humana Commercial |
$484.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$467.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$420.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$501.60
|
| Rate for Payer: Ohio Health Group HMO |
$427.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.70
|
| Rate for Payer: PHCS Commercial |
$547.20
|
| Rate for Payer: United Healthcare All Payer |
$501.60
|
|
