OS CRYOGLOBULIN
|
Facility
|
OP
|
$132.00
|
|
Service Code
|
HCPCS 82595
|
Hospital Charge Code |
30000301
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$6.47 |
Max. Negotiated Rate |
$126.72 |
Rate for Payer: Aetna Commercial |
$101.64
|
Rate for Payer: Anthem Medicaid |
$6.47
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$6.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.06
|
Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
Rate for Payer: Cash Price |
$66.00
|
Rate for Payer: Cash Price |
$66.00
|
Rate for Payer: Cigna Commercial |
$109.56
|
Rate for Payer: First Health Commercial |
$125.40
|
Rate for Payer: Humana Commercial |
$112.20
|
Rate for Payer: Humana KY Medicaid |
$6.47
|
Rate for Payer: Humana Medicare Advantage |
$6.47
|
Rate for Payer: Kentucky WC Medicaid |
$6.53
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7.76
|
Rate for Payer: Molina Healthcare Medicaid |
$6.60
|
Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
Rate for Payer: Ohio Health Group HMO |
$99.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
Rate for Payer: PHCS Commercial |
$126.72
|
Rate for Payer: United Healthcare All Payer |
$116.16
|
|
OS CRYOPRESERV FRZ/STR CELLS
|
Facility
|
OP
|
$61.00
|
|
Service Code
|
HCPCS 88240
|
Hospital Charge Code |
30001466
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$7.93 |
Max. Negotiated Rate |
$58.56 |
Rate for Payer: Aetna Commercial |
$46.97
|
Rate for Payer: Anthem Medicaid |
$13.07
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$13.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.30
|
Rate for Payer: CareSource Just4Me Medicare |
$13.07
|
Rate for Payer: Cash Price |
$30.50
|
Rate for Payer: Cash Price |
$30.50
|
Rate for Payer: Cigna Commercial |
$50.63
|
Rate for Payer: First Health Commercial |
$57.95
|
Rate for Payer: Humana Commercial |
$51.85
|
Rate for Payer: Humana KY Medicaid |
$13.07
|
Rate for Payer: Humana Medicare Advantage |
$13.07
|
Rate for Payer: Kentucky WC Medicaid |
$13.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$15.68
|
Rate for Payer: Molina Healthcare Medicaid |
$13.33
|
Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
Rate for Payer: Ohio Health Group HMO |
$45.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$12.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$7.93
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.91
|
Rate for Payer: PHCS Commercial |
$58.56
|
Rate for Payer: United Healthcare All Payer |
$53.68
|
|
OS CRYOPRESERV FRZ/STR CELLS
|
Facility
|
IP
|
$61.00
|
|
Service Code
|
HCPCS 88240
|
Hospital Charge Code |
30001466
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$7.93 |
Max. Negotiated Rate |
$58.56 |
Rate for Payer: Aetna Commercial |
$46.97
|
Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
Rate for Payer: Cash Price |
$30.50
|
Rate for Payer: Cigna Commercial |
$50.63
|
Rate for Payer: First Health Commercial |
$57.95
|
Rate for Payer: Humana Commercial |
$51.85
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$18.30
|
Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
Rate for Payer: Ohio Health Group HMO |
$45.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$12.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$7.93
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.91
|
Rate for Payer: PHCS Commercial |
$58.56
|
Rate for Payer: United Healthcare All Payer |
$53.68
|
|
OS CRYPTOCOCCUS ANTIBODY
|
Facility
|
OP
|
$94.50
|
|
Service Code
|
HCPCS 86641
|
Hospital Charge Code |
30002059
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$12.28 |
Max. Negotiated Rate |
$90.72 |
Rate for Payer: Aetna Commercial |
$72.76
|
Rate for Payer: Anthem Medicaid |
$14.41
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$14.41
|
Rate for Payer: Anthem POS/PPO/Traditional |
$75.88
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.17
|
Rate for Payer: CareSource Just4Me Medicare |
$14.41
|
Rate for Payer: Cash Price |
$47.25
|
Rate for Payer: Cash Price |
$47.25
|
Rate for Payer: Cigna Commercial |
$78.44
|
Rate for Payer: First Health Commercial |
$89.78
|
Rate for Payer: Humana Commercial |
$80.32
|
Rate for Payer: Humana KY Medicaid |
$14.41
|
Rate for Payer: Humana Medicare Advantage |
$14.41
|
Rate for Payer: Kentucky WC Medicaid |
$14.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$77.49
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$17.29
|
Rate for Payer: Molina Healthcare Medicaid |
$14.70
|
Rate for Payer: Ohio Health Choice Commercial |
$83.16
|
Rate for Payer: Ohio Health Group HMO |
$70.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$18.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$12.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.30
|
Rate for Payer: PHCS Commercial |
$90.72
|
Rate for Payer: United Healthcare All Payer |
$83.16
|
|
OS CRYPTOCOCCUS ANTIBODY
|
Facility
|
IP
|
$94.50
|
|
Service Code
|
HCPCS 86641
|
Hospital Charge Code |
30002059
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$12.28 |
Max. Negotiated Rate |
$90.72 |
Rate for Payer: Aetna Commercial |
$72.76
|
Rate for Payer: Anthem POS/PPO/Traditional |
$75.88
|
Rate for Payer: Cash Price |
$47.25
|
Rate for Payer: Cigna Commercial |
$78.44
|
Rate for Payer: First Health Commercial |
$89.78
|
Rate for Payer: Humana Commercial |
$80.32
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$77.49
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$28.35
|
Rate for Payer: Ohio Health Choice Commercial |
$83.16
|
Rate for Payer: Ohio Health Group HMO |
$70.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$18.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$12.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.30
|
Rate for Payer: PHCS Commercial |
$90.72
|
Rate for Payer: United Healthcare All Payer |
$83.16
|
|
OS CUCUMBER IGE
|
Facility
|
OP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000784
|
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 CUCUMBER IGE
|
Facility
|
IP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000784
|
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 CULTIVATED OAT IGE
|
Facility
|
OP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000643
|
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 CULTIVATED OAT IGE
|
Facility
|
IP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000643
|
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 CULTIVATED RYE GRASS IGE
|
Facility
|
IP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000825
|
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 CULTIVATED RYE GRASS IGE
|
Facility
|
OP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000825
|
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 CULTURE REFRRED FOR ID FUNG
|
Facility
|
IP
|
$96.00
|
|
Service Code
|
HCPCS 87107
|
Hospital Charge Code |
30001280
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$12.48 |
Max. Negotiated Rate |
$92.16 |
Rate for Payer: Aetna Commercial |
$73.92
|
Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
Rate for Payer: Cash Price |
$48.00
|
Rate for Payer: Cigna Commercial |
$79.68
|
Rate for Payer: First Health Commercial |
$91.20
|
Rate for Payer: Humana Commercial |
$81.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$28.80
|
Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
Rate for Payer: Ohio Health Group HMO |
$72.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
Rate for Payer: PHCS Commercial |
$92.16
|
Rate for Payer: United Healthcare All Payer |
$84.48
|
|
OS CULTURE REFRRED FOR ID FUNG
|
Facility
|
OP
|
$96.00
|
|
Service Code
|
HCPCS 87107
|
Hospital Charge Code |
30001280
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$10.32 |
Max. Negotiated Rate |
$92.16 |
Rate for Payer: Aetna Commercial |
$73.92
|
Rate for Payer: Anthem Medicaid |
$10.32
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$10.32
|
Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.45
|
Rate for Payer: CareSource Just4Me Medicare |
$10.32
|
Rate for Payer: Cash Price |
$48.00
|
Rate for Payer: Cash Price |
$48.00
|
Rate for Payer: Cigna Commercial |
$79.68
|
Rate for Payer: First Health Commercial |
$91.20
|
Rate for Payer: Humana Commercial |
$81.60
|
Rate for Payer: Humana KY Medicaid |
$10.32
|
Rate for Payer: Humana Medicare Advantage |
$10.32
|
Rate for Payer: Kentucky WC Medicaid |
$10.42
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$12.38
|
Rate for Payer: Molina Healthcare Medicaid |
$10.53
|
Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
Rate for Payer: Ohio Health Group HMO |
$72.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
Rate for Payer: PHCS Commercial |
$92.16
|
Rate for Payer: United Healthcare All Payer |
$84.48
|
|
OS CURRY IGE
|
Facility
|
IP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000887
|
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 CURRY IGE
|
Facility
|
OP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000887
|
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 CURVULARIA LUNATA IGE
|
Facility
|
OP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000682
|
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 CURVULARIA LUNATA IGE
|
Facility
|
IP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000682
|
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 CYCLIC CITRULINATED PEP AB
|
Professional
|
Both
|
$177.00
|
|
Service Code
|
HCPCS 86200
|
Hospital Charge Code |
30001000
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$7.77 |
Max. Negotiated Rate |
$177.00 |
Rate for Payer: Aetna Commercial |
$30.27
|
Rate for Payer: Buckeye Medicare Advantage |
$177.00
|
Rate for Payer: Cash Price |
$88.50
|
Rate for Payer: Cash Price |
$88.50
|
Rate for Payer: Cigna Commercial |
$11.52
|
Rate for Payer: Healthspan PPO |
$13.57
|
Rate for Payer: Multiplan PHCS |
$106.20
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$123.90
|
Rate for Payer: UHCCP Medicaid |
$61.95
|
Rate for Payer: Wellcare CHIP/Medicaid |
$7.77
|
|
OS CYCLIC CITRULINATED PEP AB
|
Facility
|
IP
|
$177.00
|
|
Service Code
|
HCPCS 86200
|
Hospital Charge Code |
30001000
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$23.01 |
Max. Negotiated Rate |
$169.92 |
Rate for Payer: Aetna Commercial |
$136.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$142.13
|
Rate for Payer: Cash Price |
$88.50
|
Rate for Payer: Cigna Commercial |
$146.91
|
Rate for Payer: First Health Commercial |
$168.15
|
Rate for Payer: Humana Commercial |
$150.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$145.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.63
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$53.10
|
Rate for Payer: Ohio Health Choice Commercial |
$155.76
|
Rate for Payer: Ohio Health Group HMO |
$132.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$23.01
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.87
|
Rate for Payer: PHCS Commercial |
$169.92
|
Rate for Payer: United Healthcare All Payer |
$155.76
|
|
OS CYCLIC CITRULINATED PEP AB
|
Facility
|
OP
|
$177.00
|
|
Service Code
|
HCPCS 86200
|
Hospital Charge Code |
30001000
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$12.95 |
Max. Negotiated Rate |
$169.92 |
Rate for Payer: Aetna Commercial |
$136.29
|
Rate for Payer: Anthem Medicaid |
$12.95
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$142.13
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.13
|
Rate for Payer: CareSource Just4Me Medicare |
$12.95
|
Rate for Payer: Cash Price |
$88.50
|
Rate for Payer: Cash Price |
$88.50
|
Rate for Payer: Cigna Commercial |
$146.91
|
Rate for Payer: First Health Commercial |
$168.15
|
Rate for Payer: Humana Commercial |
$150.45
|
Rate for Payer: Humana KY Medicaid |
$12.95
|
Rate for Payer: Humana Medicare Advantage |
$12.95
|
Rate for Payer: Kentucky WC Medicaid |
$13.08
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$145.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.63
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$15.54
|
Rate for Payer: Molina Healthcare Medicaid |
$13.21
|
Rate for Payer: Ohio Health Choice Commercial |
$155.76
|
Rate for Payer: Ohio Health Group HMO |
$132.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$23.01
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.87
|
Rate for Payer: PHCS Commercial |
$169.92
|
Rate for Payer: United Healthcare All Payer |
$155.76
|
|
OS CYCLOSPORINE BLOOD
|
Facility
|
OP
|
$219.00
|
|
Service Code
|
HCPCS 80158
|
Hospital Charge Code |
30000023
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$18.05 |
Max. Negotiated Rate |
$210.24 |
Rate for Payer: Aetna Commercial |
$168.63
|
Rate for Payer: Anthem Medicaid |
$18.05
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$18.05
|
Rate for Payer: Anthem POS/PPO/Traditional |
$175.86
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.27
|
Rate for Payer: CareSource Just4Me Medicare |
$18.05
|
Rate for Payer: Cash Price |
$109.50
|
Rate for Payer: Cash Price |
$109.50
|
Rate for Payer: Cigna Commercial |
$181.77
|
Rate for Payer: First Health Commercial |
$208.05
|
Rate for Payer: Humana Commercial |
$186.15
|
Rate for Payer: Humana KY Medicaid |
$18.05
|
Rate for Payer: Humana Medicare Advantage |
$18.05
|
Rate for Payer: Kentucky WC Medicaid |
$18.23
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$179.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$21.66
|
Rate for Payer: Molina Healthcare Medicaid |
$18.41
|
Rate for Payer: Ohio Health Choice Commercial |
$192.72
|
Rate for Payer: Ohio Health Group HMO |
$164.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$43.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$28.47
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.89
|
Rate for Payer: PHCS Commercial |
$210.24
|
Rate for Payer: United Healthcare All Payer |
$192.72
|
|
OS CYCLOSPORINE BLOOD
|
Facility
|
IP
|
$219.00
|
|
Service Code
|
HCPCS 80158
|
Hospital Charge Code |
30000023
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$28.47 |
Max. Negotiated Rate |
$210.24 |
Rate for Payer: Aetna Commercial |
$168.63
|
Rate for Payer: Anthem POS/PPO/Traditional |
$175.86
|
Rate for Payer: Cash Price |
$109.50
|
Rate for Payer: Cigna Commercial |
$181.77
|
Rate for Payer: First Health Commercial |
$208.05
|
Rate for Payer: Humana Commercial |
$186.15
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$179.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$65.70
|
Rate for Payer: Ohio Health Choice Commercial |
$192.72
|
Rate for Payer: Ohio Health Group HMO |
$164.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$43.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$28.47
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.89
|
Rate for Payer: PHCS Commercial |
$210.24
|
Rate for Payer: United Healthcare All Payer |
$192.72
|
|
OS CYP2C19 ANTIDEPRESSANT
|
Facility
|
IP
|
$268.00
|
|
Service Code
|
HCPCS 81225
|
Hospital Charge Code |
30000183
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$34.84 |
Max. Negotiated Rate |
$257.28 |
Rate for Payer: Aetna Commercial |
$206.36
|
Rate for Payer: Anthem POS/PPO/Traditional |
$215.20
|
Rate for Payer: Cash Price |
$134.00
|
Rate for Payer: Cigna Commercial |
$222.44
|
Rate for Payer: First Health Commercial |
$254.60
|
Rate for Payer: Humana Commercial |
$227.80
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$219.76
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.78
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$80.40
|
Rate for Payer: Ohio Health Choice Commercial |
$235.84
|
Rate for Payer: Ohio Health Group HMO |
$201.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$34.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.08
|
Rate for Payer: PHCS Commercial |
$257.28
|
Rate for Payer: United Healthcare All Payer |
$235.84
|
|
OS CYP2C19 ANTIDEPRESSANT
|
Facility
|
OP
|
$268.00
|
|
Service Code
|
HCPCS 81225
|
Hospital Charge Code |
30000183
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$34.84 |
Max. Negotiated Rate |
$407.90 |
Rate for Payer: Aetna Commercial |
$206.36
|
Rate for Payer: Anthem Medicaid |
$291.36
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$291.36
|
Rate for Payer: Anthem POS/PPO/Traditional |
$215.20
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$407.90
|
Rate for Payer: CareSource Just4Me Medicare |
$291.36
|
Rate for Payer: Cash Price |
$134.00
|
Rate for Payer: Cash Price |
$134.00
|
Rate for Payer: Cigna Commercial |
$222.44
|
Rate for Payer: First Health Commercial |
$254.60
|
Rate for Payer: Humana Commercial |
$227.80
|
Rate for Payer: Humana KY Medicaid |
$291.36
|
Rate for Payer: Humana Medicare Advantage |
$291.36
|
Rate for Payer: Kentucky WC Medicaid |
$294.27
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$219.76
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.78
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$349.63
|
Rate for Payer: Molina Healthcare Medicaid |
$297.19
|
Rate for Payer: Ohio Health Choice Commercial |
$235.84
|
Rate for Payer: Ohio Health Group HMO |
$201.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$34.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.08
|
Rate for Payer: PHCS Commercial |
$257.28
|
Rate for Payer: United Healthcare All Payer |
$235.84
|
|
OS CYP2C9 GENE COM VARIANTS
|
Facility
|
IP
|
$186.00
|
|
Service Code
|
HCPCS 81227
|
Hospital Charge Code |
30002006
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$24.18 |
Max. Negotiated Rate |
$178.56 |
Rate for Payer: Aetna Commercial |
$143.22
|
Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
Rate for Payer: Cash Price |
$93.00
|
Rate for Payer: Cigna Commercial |
$154.38
|
Rate for Payer: First Health Commercial |
$176.70
|
Rate for Payer: Humana Commercial |
$158.10
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
Rate for Payer: Ohio Health Group HMO |
$139.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
Rate for Payer: PHCS Commercial |
$178.56
|
Rate for Payer: United Healthcare All Payer |
$163.68
|
|