|
OS HBG A1C
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30000363
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$13.80
|
| Rate for Payer: Healthspan PPO |
$10.17
|
| Rate for Payer: Multiplan PHCS |
$39.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.20
|
| Rate for Payer: UHCCP Medicaid |
$23.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.83
|
|
|
OS HBG A1C
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30000363
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$9.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.71
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Humana KY Medicaid |
$9.71
|
| Rate for Payer: Humana Medicare Advantage |
$9.71
|
| Rate for Payer: Kentucky WC Medicaid |
$9.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.46
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
OS HCG TOTAL
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
30000561
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$15.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.05
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$15.05
|
| Rate for Payer: Humana Medicare Advantage |
$15.05
|
| Rate for Payer: Kentucky WC Medicaid |
$15.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
OS HCG TOTAL
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
30000561
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
OS HCV AMPLIFICATION
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 87521
|
| Hospital Charge Code |
30001376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$190.07
|
| Rate for Payer: First Health Commercial |
$217.55
|
| Rate for Payer: Humana Commercial |
$194.65
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$187.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$201.52
|
| Rate for Payer: Ohio Health Group HMO |
$171.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.99
|
| Rate for Payer: PHCS Commercial |
$219.84
|
| Rate for Payer: United Healthcare All Payer |
$201.52
|
|
|
OS HCV AMPLIFICATION
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS 87521
|
| Hospital Charge Code |
30001376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.89
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$190.07
|
| Rate for Payer: First Health Commercial |
$217.55
|
| Rate for Payer: Humana Commercial |
$194.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$187.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$201.52
|
| Rate for Payer: Ohio Health Group HMO |
$171.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.99
|
| Rate for Payer: PHCS Commercial |
$219.84
|
| Rate for Payer: United Healthcare All Payer |
$201.52
|
|
|
OS HCV FIBROSURE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 81596
|
| Hospital Charge Code |
30000218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem Medicaid |
$72.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$72.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$101.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.19
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Humana KY Medicaid |
$72.19
|
| Rate for Payer: Humana Medicare Advantage |
$72.19
|
| Rate for Payer: Kentucky WC Medicaid |
$72.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
OS HCV FIBROSURE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 81596
|
| Hospital Charge Code |
30000218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.78
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
OS HCV GENOTYPE
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
30001415
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.91 |
| Max. Negotiated Rate |
$294.72 |
| Rate for Payer: Aetna Commercial |
$236.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$246.52
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cigna Commercial |
$254.81
|
| Rate for Payer: First Health Commercial |
$291.65
|
| Rate for Payer: Humana Commercial |
$260.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$251.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$270.16
|
| Rate for Payer: Ohio Health Group HMO |
$230.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.17
|
| Rate for Payer: PHCS Commercial |
$294.72
|
| Rate for Payer: United Healthcare All Payer |
$270.16
|
|
|
OS HCV GENOTYPE
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
30001415
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.91 |
| Max. Negotiated Rate |
$360.43 |
| Rate for Payer: Aetna Commercial |
$236.39
|
| Rate for Payer: Anthem Medicaid |
$257.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$257.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$246.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$360.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$257.45
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cigna Commercial |
$254.81
|
| Rate for Payer: First Health Commercial |
$291.65
|
| Rate for Payer: Humana Commercial |
$260.95
|
| Rate for Payer: Humana KY Medicaid |
$257.45
|
| Rate for Payer: Humana Medicare Advantage |
$257.45
|
| Rate for Payer: Kentucky WC Medicaid |
$260.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$251.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$308.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$270.16
|
| Rate for Payer: Ohio Health Group HMO |
$230.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.17
|
| Rate for Payer: PHCS Commercial |
$294.72
|
| Rate for Payer: United Healthcare All Payer |
$270.16
|
|
|
OS HEAVY METAL QUANT EACH NES
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
30001932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$461.76 |
| Rate for Payer: Aetna Commercial |
$370.37
|
| Rate for Payer: Anthem Medicaid |
$21.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.96
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cigna Commercial |
$399.23
|
| Rate for Payer: First Health Commercial |
$456.95
|
| Rate for Payer: Humana Commercial |
$408.85
|
| Rate for Payer: Humana KY Medicaid |
$21.96
|
| Rate for Payer: Humana Medicare Advantage |
$21.96
|
| Rate for Payer: Kentucky WC Medicaid |
$22.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.28
|
| Rate for Payer: Ohio Health Group HMO |
$360.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.11
|
| Rate for Payer: PHCS Commercial |
$461.76
|
| Rate for Payer: United Healthcare All Payer |
$423.28
|
|
|
OS HEAVY METAL QUANT EACH NES
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
30001932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.53 |
| Max. Negotiated Rate |
$461.76 |
| Rate for Payer: Aetna Commercial |
$370.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.24
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cigna Commercial |
$399.23
|
| Rate for Payer: First Health Commercial |
$456.95
|
| Rate for Payer: Humana Commercial |
$408.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.28
|
| Rate for Payer: Ohio Health Group HMO |
$360.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.11
|
| Rate for Payer: PHCS Commercial |
$461.76
|
| Rate for Payer: United Healthcare All Payer |
$423.28
|
|
|
OS HEAVYMET SCREEN W/DEMO B
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
HCPCS 83015
|
| Hospital Charge Code |
30000358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$444.48 |
| Rate for Payer: Aetna Commercial |
$356.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$371.79
|
| Rate for Payer: Cash Price |
$231.50
|
| Rate for Payer: Cigna Commercial |
$384.29
|
| Rate for Payer: First Health Commercial |
$439.85
|
| Rate for Payer: Humana Commercial |
$393.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.44
|
| Rate for Payer: Ohio Health Group HMO |
$347.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.53
|
| Rate for Payer: PHCS Commercial |
$444.48
|
| Rate for Payer: United Healthcare All Payer |
$407.44
|
|
|
OS HEAVYMET SCREEN W/DEMO B
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
HCPCS 83015
|
| Hospital Charge Code |
30000358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$444.48 |
| Rate for Payer: Aetna Commercial |
$356.51
|
| Rate for Payer: Anthem Medicaid |
$20.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$371.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.94
|
| Rate for Payer: Cash Price |
$231.50
|
| Rate for Payer: Cash Price |
$231.50
|
| Rate for Payer: Cigna Commercial |
$384.29
|
| Rate for Payer: First Health Commercial |
$439.85
|
| Rate for Payer: Humana Commercial |
$393.55
|
| Rate for Payer: Humana KY Medicaid |
$20.94
|
| Rate for Payer: Humana Medicare Advantage |
$20.94
|
| Rate for Payer: Kentucky WC Medicaid |
$21.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.44
|
| Rate for Payer: Ohio Health Group HMO |
$347.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.53
|
| Rate for Payer: PHCS Commercial |
$444.48
|
| Rate for Payer: United Healthcare All Payer |
$407.44
|
|
|
OS HEMOCHR HFE GENE ANALY B
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 81256
|
| Hospital Charge Code |
30000190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.29 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem Medicaid |
$65.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$267.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$91.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.36
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Humana KY Medicaid |
$65.36
|
| Rate for Payer: Humana Medicare Advantage |
$65.36
|
| Rate for Payer: Kentucky WC Medicaid |
$66.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.23
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
OS HEMOCHR HFE GENE ANALY B
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 81256
|
| Hospital Charge Code |
30000190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.29 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$267.40
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.23
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
OS HEMOGLB-OXGN AFFINITY
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
HCPCS 82820
|
| Hospital Charge Code |
30000336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.88 |
| Max. Negotiated Rate |
$552.96 |
| Rate for Payer: Aetna Commercial |
$443.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$462.53
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$478.08
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: Humana Commercial |
$489.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$472.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$425.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.88
|
| Rate for Payer: Ohio Health Group HMO |
$432.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.56
|
| Rate for Payer: PHCS Commercial |
$552.96
|
| Rate for Payer: United Healthcare All Payer |
$506.88
|
|
|
OS HEMOGLB-OXGN AFFINITY
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
HCPCS 82820
|
| Hospital Charge Code |
30000336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$552.96 |
| Rate for Payer: Aetna Commercial |
$443.52
|
| Rate for Payer: Anthem Medicaid |
$13.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$462.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.34
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$478.08
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: Humana Commercial |
$489.60
|
| Rate for Payer: Humana KY Medicaid |
$13.34
|
| Rate for Payer: Humana Medicare Advantage |
$13.34
|
| Rate for Payer: Kentucky WC Medicaid |
$13.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$472.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$425.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.88
|
| Rate for Payer: Ohio Health Group HMO |
$432.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.56
|
| Rate for Payer: PHCS Commercial |
$552.96
|
| Rate for Payer: United Healthcare All Payer |
$506.88
|
|
|
OS HEMOGLOB F RBC DISTRIBUTON
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
30001429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$435.16 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$34.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$310.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$435.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$419.62
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$34.20
|
| Rate for Payer: Humana Medicare Advantage |
$310.83
|
| Rate for Payer: Kentucky WC Medicaid |
$34.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
OS HEMOGLOB F RBC DISTRIBUTON
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
30001429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.34
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
OS HEMOGLOBIN A2 AND F
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
30000361
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.07
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.67
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
OS HEMOGLOBIN A2 AND F
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
30000361
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem Medicaid |
$18.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.06
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Humana KY Medicaid |
$18.06
|
| Rate for Payer: Humana Medicare Advantage |
$18.06
|
| Rate for Payer: Kentucky WC Medicaid |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.67
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
OS HEMOGLOBIN ELECTROPHORES
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
30000360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem Medicaid |
$12.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.87
|
| 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 |
$12.87
|
| Rate for Payer: Humana Medicare Advantage |
$12.87
|
| Rate for Payer: Kentucky WC Medicaid |
$13.00
|
| 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 |
$15.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.13
|
| 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 HEMOGLOBIN ELECTROPHORES
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
30000360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| 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: 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 |
$39.60
|
| 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 Hemoglobin SF
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
30000515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.03
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.02
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
