|
OS HERPES SIMPLEX TYPE 1
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
30001172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$13.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.19
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$13.19
|
| Rate for Payer: Humana Medicare Advantage |
$13.19
|
| Rate for Payer: Kentucky WC Medicaid |
$13.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS HERPES SIMPLEX TYPE 1
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
30001172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS HERPES SIMPLEX TYPE 2
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
30001173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$19.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.35
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Humana KY Medicaid |
$19.35
|
| Rate for Payer: Humana Medicare Advantage |
$19.35
|
| Rate for Payer: Kentucky WC Medicaid |
$19.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.07
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
OS HERPES SIMPLEX TYPE 2
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
30001173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.07
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
OS HERPES SIMPLEX VIRUS PCR
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
30001378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$376.32 |
| Rate for Payer: Aetna Commercial |
$301.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$314.78
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cigna Commercial |
$325.36
|
| Rate for Payer: First Health Commercial |
$372.40
|
| Rate for Payer: Humana Commercial |
$333.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$321.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$289.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.96
|
| Rate for Payer: Ohio Health Group HMO |
$294.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.52
|
| Rate for Payer: PHCS Commercial |
$376.32
|
| Rate for Payer: United Healthcare All Payer |
$344.96
|
|
|
OS HERPES SIMPLEX VIRUS PCR
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
30001378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$376.32 |
| Rate for Payer: Aetna Commercial |
$301.84
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$314.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cigna Commercial |
$325.36
|
| Rate for Payer: First Health Commercial |
$372.40
|
| Rate for Payer: Humana Commercial |
$333.20
|
| 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 |
$321.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$289.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.96
|
| Rate for Payer: Ohio Health Group HMO |
$294.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.52
|
| Rate for Payer: PHCS Commercial |
$376.32
|
| Rate for Payer: United Healthcare All Payer |
$344.96
|
|
|
OS HERRING IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000811
|
|
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 HERRING IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000811
|
|
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 HEXA GENE
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 81255
|
| Hospital Charge Code |
30001914
|
|
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 HEXA GENE
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 81255
|
| Hospital Charge Code |
30001914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$72.03 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$51.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$72.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.45
|
| 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 |
$51.45
|
| Rate for Payer: Humana Medicare Advantage |
$51.45
|
| Rate for Payer: Kentucky WC Medicaid |
$51.96
|
| 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 |
$61.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.48
|
| 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 HHV-6 DNA AMP PROBE
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
HCPCS 87532
|
| Hospital Charge Code |
30001881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$204.48 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.04
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$176.79
|
| Rate for Payer: First Health Commercial |
$202.35
|
| Rate for Payer: Humana Commercial |
$181.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$174.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$187.44
|
| Rate for Payer: Ohio Health Group HMO |
$159.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.03
|
| Rate for Payer: PHCS Commercial |
$204.48
|
| Rate for Payer: United Healthcare All Payer |
$187.44
|
|
|
OS HHV-6 DNA AMP PROBE
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
HCPCS 87532
|
| Hospital Charge Code |
30001881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$204.48 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$176.79
|
| Rate for Payer: First Health Commercial |
$202.35
|
| Rate for Payer: Humana Commercial |
$181.05
|
| 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 |
$174.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$187.44
|
| Rate for Payer: Ohio Health Group HMO |
$159.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.03
|
| Rate for Payer: PHCS Commercial |
$204.48
|
| Rate for Payer: United Healthcare All Payer |
$187.44
|
|
|
OS HHV-6 DNA QUANT
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
HCPCS 87533
|
| Hospital Charge Code |
30001880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem Medicaid |
$41.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$58.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.76
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Humana KY Medicaid |
$41.76
|
| Rate for Payer: Humana Medicare Advantage |
$41.76
|
| Rate for Payer: Kentucky WC Medicaid |
$42.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.92
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
OS HHV-6 DNA QUANT
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
HCPCS 87533
|
| Hospital Charge Code |
30001880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.16 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.40
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.92
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
OS HIGH SENSITIVITY CRP
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
30000981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem Medicaid |
$12.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.95
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| 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 |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.17
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
OS HIGH SENSITIVITY CRP
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
30000981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Aetna Commercial |
$30.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.00
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$11.52
|
| Rate for Payer: Healthspan PPO |
$13.57
|
| Rate for Payer: Multiplan PHCS |
$64.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.90
|
| Rate for Payer: UHCCP Medicaid |
$37.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.77
|
|
|
OS HIGH SENSITIVITY CRP
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
30000981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.92
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.17
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
OS HISTAMINE
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
30001821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
OS HISTAMINE
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
30001821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$29.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.53
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$29.53
|
| Rate for Payer: Humana Medicare Advantage |
$29.53
|
| Rate for Payer: Kentucky WC Medicaid |
$29.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
OS HISTOPLASMA AB 1
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
|
OS HISTOPLASMA AB 1
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem Medicaid |
$13.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.79
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Humana KY Medicaid |
$13.79
|
| Rate for Payer: Humana Medicare Advantage |
$13.79
|
| Rate for Payer: Kentucky WC Medicaid |
$13.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
|
OS HISTOPLASMA AB 2
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001175
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
|
OS HISTOPLASMA AB 2
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001175
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem Medicaid |
$13.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.79
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Humana KY Medicaid |
$13.79
|
| Rate for Payer: Humana Medicare Advantage |
$13.79
|
| Rate for Payer: Kentucky WC Medicaid |
$13.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
|
OS HISTOPLASMA AB 3
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
|
OS HISTOPLASMA AB 3
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem Medicaid |
$13.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.79
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Humana KY Medicaid |
$13.79
|
| Rate for Payer: Humana Medicare Advantage |
$13.79
|
| Rate for Payer: Kentucky WC Medicaid |
$13.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
