|
OS GAD65 AB ASSAY S
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
30001075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.46
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.97
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
OS GAD65 AB ASSAY S
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
30001075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem Medicaid |
$23.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.57
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Humana KY Medicaid |
$23.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.57
|
| Rate for Payer: Kentucky WC Medicaid |
$23.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.97
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
OS GASCA
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
30001161
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem Medicaid |
$12.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.25
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Humana KY Medicaid |
$12.25
|
| Rate for Payer: Humana Medicare Advantage |
$12.25
|
| Rate for Payer: Kentucky WC Medicaid |
$12.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.73
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
OS GASCA
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
30001161
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.65
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.73
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
OS GASTRIN SERUM
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 82941
|
| Hospital Charge Code |
30000337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$161.40
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$166.83
|
| Rate for Payer: First Health Commercial |
$190.95
|
| Rate for Payer: Humana Commercial |
$170.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.88
|
| Rate for Payer: Ohio Health Group HMO |
$150.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.31
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
OS GASTRIN SERUM
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 82941
|
| Hospital Charge Code |
30000337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem Medicaid |
$17.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$161.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.63
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$166.83
|
| Rate for Payer: First Health Commercial |
$190.95
|
| Rate for Payer: Humana Commercial |
$170.85
|
| Rate for Payer: Humana KY Medicaid |
$17.63
|
| Rate for Payer: Humana Medicare Advantage |
$17.63
|
| Rate for Payer: Kentucky WC Medicaid |
$17.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.88
|
| Rate for Payer: Ohio Health Group HMO |
$150.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.31
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
OS GBA GENE
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 81251
|
| Hospital Charge Code |
30001913
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.88
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS GBA GENE
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 81251
|
| Hospital Charge Code |
30001913
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$47.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$47.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$66.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.25
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Humana KY Medicaid |
$47.25
|
| Rate for Payer: Humana Medicare Advantage |
$47.25
|
| Rate for Payer: Kentucky WC Medicaid |
$47.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.88
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS GD1A IGG
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000405
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS GD1A IGG
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000405
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS GD1A IGM
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000396
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS GD1A IGM
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000396
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS GD1B IGG
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000397
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS GD1B IGG
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000397
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS GD1B IGM
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000413
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
OS GD1B IGM
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000413
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
OS GENOTYPE DNA/RNA HIV
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
HCPCS 87906
|
| Hospital Charge Code |
30002019
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$82.55 |
| Max. Negotiated Rate |
$609.60 |
| Rate for Payer: Aetna Commercial |
$488.95
|
| Rate for Payer: Anthem Medicaid |
$128.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$128.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$509.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$180.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.73
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$527.05
|
| Rate for Payer: First Health Commercial |
$603.25
|
| Rate for Payer: Humana Commercial |
$539.75
|
| Rate for Payer: Humana KY Medicaid |
$128.73
|
| Rate for Payer: Humana Medicare Advantage |
$128.73
|
| Rate for Payer: Kentucky WC Medicaid |
$130.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$131.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.80
|
| Rate for Payer: Ohio Health Group HMO |
$476.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.85
|
| Rate for Payer: PHCS Commercial |
$609.60
|
| Rate for Payer: United Healthcare All Payer |
$558.80
|
|
|
OS GENOTYPE DNA/RNA HIV
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
HCPCS 87906
|
| Hospital Charge Code |
30002019
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$82.55 |
| Max. Negotiated Rate |
$609.60 |
| Rate for Payer: Aetna Commercial |
$488.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$509.90
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$527.05
|
| Rate for Payer: First Health Commercial |
$603.25
|
| Rate for Payer: Humana Commercial |
$539.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.80
|
| Rate for Payer: Ohio Health Group HMO |
$476.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.85
|
| Rate for Payer: PHCS Commercial |
$609.60
|
| Rate for Payer: United Healthcare All Payer |
$558.80
|
|
|
OS GGT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
30000350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.36
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
OS GGT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
30000350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem Medicaid |
$7.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.20
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Humana KY Medicaid |
$7.20
|
| Rate for Payer: Humana Medicare Advantage |
$7.20
|
| Rate for Payer: Kentucky WC Medicaid |
$7.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.36
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
OS GINGER IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000846
|
|
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 GINGER IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000846
|
|
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 GI PATHOGEN PANEL, PCR, F
|
Facility
|
OP
|
$1,091.00
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30002040
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$1,047.36 |
| Rate for Payer: Aetna Commercial |
$840.07
|
| Rate for Payer: Anthem Medicaid |
$416.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$416.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$583.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$416.78
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cigna Commercial |
$905.53
|
| Rate for Payer: First Health Commercial |
$1,036.45
|
| Rate for Payer: Humana Commercial |
$927.35
|
| Rate for Payer: Humana KY Medicaid |
$416.78
|
| Rate for Payer: Humana Medicare Advantage |
$416.78
|
| Rate for Payer: Kentucky WC Medicaid |
$420.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$500.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.08
|
| Rate for Payer: Ohio Health Group HMO |
$818.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.21
|
| Rate for Payer: PHCS Commercial |
$1,047.36
|
| Rate for Payer: United Healthcare All Payer |
$960.08
|
|
|
OS GI PATHOGEN PANEL, PCR, F
|
Facility
|
IP
|
$1,091.00
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30002040
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$1,047.36 |
| Rate for Payer: Aetna Commercial |
$840.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.07
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cigna Commercial |
$905.53
|
| Rate for Payer: First Health Commercial |
$1,036.45
|
| Rate for Payer: Humana Commercial |
$927.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.08
|
| Rate for Payer: Ohio Health Group HMO |
$818.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.21
|
| Rate for Payer: PHCS Commercial |
$1,047.36
|
| Rate for Payer: United Healthcare All Payer |
$960.08
|
|
|
OS GLIADIN DEAMIDATED AB IGA S
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 86258
|
| Hospital Charge Code |
30000376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.22
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
