|
OS CMV DNA DETECT/QUANT P
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
30001370
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna Commercial |
$438.90
|
| Rate for Payer: Anthem Medicaid |
$42.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$457.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.84
|
| Rate for Payer: Cash Price |
$285.00
|
| 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: Humana KY Medicaid |
$42.84
|
| Rate for Payer: Humana Medicare Advantage |
$42.84
|
| Rate for Payer: Kentucky WC Medicaid |
$43.27
|
| 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 |
$51.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.70
|
| 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
|
|
|
OS COAG FACTOR II ASSAY P
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
30000576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.11
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
OS COAG FACTOR II ASSAY P
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
30000576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$12.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.98
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$12.98
|
| Rate for Payer: Humana Medicare Advantage |
$12.98
|
| Rate for Payer: Kentucky WC Medicaid |
$13.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
OS COAG FACTOR IX ASSAY P
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
30000583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.32
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
OS COAG FACTOR IX ASSAY P
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
30000583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$19.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.04
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$19.04
|
| Rate for Payer: Humana Medicare Advantage |
$19.04
|
| Rate for Payer: Kentucky WC Medicaid |
$19.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
OS COAG FACTOR V ASSAY P
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
30000577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$295.68 |
| Rate for Payer: Aetna Commercial |
$237.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$247.32
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$255.64
|
| Rate for Payer: First Health Commercial |
$292.60
|
| Rate for Payer: Humana Commercial |
$261.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$252.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$227.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.04
|
| Rate for Payer: Ohio Health Group HMO |
$231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.48
|
| Rate for Payer: PHCS Commercial |
$295.68
|
| Rate for Payer: United Healthcare All Payer |
$271.04
|
|
|
OS COAG FACTOR V ASSAY P
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
30000577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$295.68 |
| Rate for Payer: Aetna Commercial |
$237.16
|
| Rate for Payer: Anthem Medicaid |
$17.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$247.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.65
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$255.64
|
| Rate for Payer: First Health Commercial |
$292.60
|
| Rate for Payer: Humana Commercial |
$261.80
|
| Rate for Payer: Humana KY Medicaid |
$17.65
|
| Rate for Payer: Humana Medicare Advantage |
$17.65
|
| Rate for Payer: Kentucky WC Medicaid |
$17.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$252.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$227.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.04
|
| Rate for Payer: Ohio Health Group HMO |
$231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.48
|
| Rate for Payer: PHCS Commercial |
$295.68
|
| Rate for Payer: United Healthcare All Payer |
$271.04
|
|
|
OS COAG FACTOR VII ASSAY P
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
30000578
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna Commercial |
$334.95
|
| Rate for Payer: Anthem Medicaid |
$17.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$349.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.90
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: First Health Commercial |
$413.25
|
| Rate for Payer: Humana Commercial |
$369.75
|
| Rate for Payer: Humana KY Medicaid |
$17.90
|
| Rate for Payer: Humana Medicare Advantage |
$17.90
|
| Rate for Payer: Kentucky WC Medicaid |
$18.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$356.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$382.80
|
| Rate for Payer: Ohio Health Group HMO |
$326.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.85
|
| Rate for Payer: PHCS Commercial |
$417.60
|
| Rate for Payer: United Healthcare All Payer |
$382.80
|
|
|
OS COAG FACTOR VII ASSAY P
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
30000578
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna Commercial |
$334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$349.30
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: First Health Commercial |
$413.25
|
| Rate for Payer: Humana Commercial |
$369.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$356.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$382.80
|
| Rate for Payer: Ohio Health Group HMO |
$326.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.85
|
| Rate for Payer: PHCS Commercial |
$417.60
|
| Rate for Payer: United Healthcare All Payer |
$382.80
|
|
|
OS COAG FACTOR VIII ACTI ASSA
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
30000579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$240.90
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
OS COAG FACTOR VIII ACTI ASSA
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
30000579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$17.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$240.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.90
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$17.90
|
| Rate for Payer: Humana Medicare Advantage |
$17.90
|
| Rate for Payer: Kentucky WC Medicaid |
$18.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
OS COAG FACTOR X ASSAY
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
30000584
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$214.83
|
| Rate for Payer: Anthem Medicaid |
$17.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.90
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$231.57
|
| Rate for Payer: First Health Commercial |
$265.05
|
| Rate for Payer: Humana Commercial |
$237.15
|
| Rate for Payer: Humana KY Medicaid |
$17.90
|
| Rate for Payer: Humana Medicare Advantage |
$17.90
|
| Rate for Payer: Kentucky WC Medicaid |
$18.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$228.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$245.52
|
| Rate for Payer: Ohio Health Group HMO |
$209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.49
|
| Rate for Payer: PHCS Commercial |
$267.84
|
| Rate for Payer: United Healthcare All Payer |
$245.52
|
|
|
OS COAG FACTOR X ASSAY
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
30000584
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$214.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.04
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$231.57
|
| Rate for Payer: First Health Commercial |
$265.05
|
| Rate for Payer: Humana Commercial |
$237.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$228.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$245.52
|
| Rate for Payer: Ohio Health Group HMO |
$209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.49
|
| Rate for Payer: PHCS Commercial |
$267.84
|
| Rate for Payer: United Healthcare All Payer |
$245.52
|
|
|
OS COAG FACTOR XI ASSAY P
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
30000585
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem Medicaid |
$17.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.90
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Humana KY Medicaid |
$17.90
|
| Rate for Payer: Humana Medicare Advantage |
$17.90
|
| Rate for Payer: Kentucky WC Medicaid |
$18.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.66
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
OS COAG FACTOR XI ASSAY P
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
30000585
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.66
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.66
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
OS COAG FACTOR XII ASSAY P
|
Facility
|
IP
|
$272.46
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
30000586
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$261.56 |
| Rate for Payer: Aetna Commercial |
$209.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.79
|
| Rate for Payer: Cash Price |
$136.23
|
| Rate for Payer: Cigna Commercial |
$226.14
|
| Rate for Payer: First Health Commercial |
$258.84
|
| Rate for Payer: Humana Commercial |
$231.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.76
|
| Rate for Payer: Ohio Health Group HMO |
$204.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.46
|
| Rate for Payer: PHCS Commercial |
$261.56
|
| Rate for Payer: United Healthcare All Payer |
$239.76
|
|
|
OS COAG FACTOR XII ASSAY P
|
Facility
|
OP
|
$272.46
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
30000586
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$261.56 |
| Rate for Payer: Aetna Commercial |
$209.79
|
| Rate for Payer: Anthem Medicaid |
$19.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.35
|
| Rate for Payer: Cash Price |
$136.23
|
| Rate for Payer: Cash Price |
$136.23
|
| Rate for Payer: Cigna Commercial |
$226.14
|
| Rate for Payer: First Health Commercial |
$258.84
|
| Rate for Payer: Humana Commercial |
$231.59
|
| Rate for Payer: Humana KY Medicaid |
$19.35
|
| Rate for Payer: Humana Medicare Advantage |
$19.35
|
| Rate for Payer: Kentucky WC Medicaid |
$19.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.76
|
| Rate for Payer: Ohio Health Group HMO |
$204.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.46
|
| Rate for Payer: PHCS Commercial |
$261.56
|
| Rate for Payer: United Healthcare All Payer |
$239.76
|
|
|
OS COCAINE CONFIRMATION
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$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 |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
OS COCAINE CONFIRMATION
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
OS COCAINE CONFIRMATION U
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.74
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
OS COCAINE CONFIRMATION U
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| 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 |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.74
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
OS COCAINE & METABOLITE URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS COCAINE & METABOLITE URINE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80353
|
| Hospital Charge Code |
30000126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$26.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Multiplan PHCS |
$15.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.20
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
|
|
OS COCAINE & METABOLITE URINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS COCAINE MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
