|
OS HISTOPLASMA AB SCREEN S
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.70
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
OS HISTOPLASMA AB SCREEN S
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$13.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.79
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| 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 |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.70
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
OS HISTOPLASMA ANTIGEN
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.54
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
OS HISTOPLASMA ANTIGEN
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
OS HISTOPLASMA ANTIGEN BR WASH
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
OS HISTOPLASMA ANTIGEN BR WASH
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.54
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
OS HISTOPLASMA ANTIGEN PCR
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$363.84 |
| Rate for Payer: Aetna Commercial |
$291.83
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$189.50
|
| Rate for Payer: Cash Price |
$189.50
|
| Rate for Payer: Cigna Commercial |
$314.57
|
| Rate for Payer: First Health Commercial |
$360.05
|
| Rate for Payer: Humana Commercial |
$322.15
|
| 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 |
$310.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$279.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$333.52
|
| Rate for Payer: Ohio Health Group HMO |
$284.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.49
|
| Rate for Payer: PHCS Commercial |
$363.84
|
| Rate for Payer: United Healthcare All Payer |
$333.52
|
|
|
OS HISTOPLASMA ANTIGEN PCR
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$363.84 |
| Rate for Payer: Aetna Commercial |
$291.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.34
|
| Rate for Payer: Cash Price |
$189.50
|
| Rate for Payer: Cigna Commercial |
$314.57
|
| Rate for Payer: First Health Commercial |
$360.05
|
| Rate for Payer: Humana Commercial |
$322.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$310.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$279.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$333.52
|
| Rate for Payer: Ohio Health Group HMO |
$284.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.49
|
| Rate for Payer: PHCS Commercial |
$363.84
|
| Rate for Payer: United Healthcare All Payer |
$333.52
|
|
|
OS HISTOPLASMOSIS URINE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.54
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
OS HISTOPLASMOSIS URINE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
OS HIV
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
30001181
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
OS HIV
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
30001181
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem Medicaid |
$13.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.71
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Humana KY Medicaid |
$13.71
|
| Rate for Payer: Humana Medicare Advantage |
$13.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
OS HIV1 AB DIFFERENTIATION S
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
30001179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem Medicaid |
$8.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$285.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.89
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Humana KY Medicaid |
$8.89
|
| Rate for Payer: Humana Medicare Advantage |
$8.89
|
| Rate for Payer: Kentucky WC Medicaid |
$8.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
OS HIV1 AB DIFFERENTIATION S
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
30001179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$285.06
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
OS HIV1 GENOTYPIC PRRT RESISTP
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS 87901
|
| Hospital Charge Code |
30001414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.41
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.62
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
OS HIV1 GENOTYPIC PRRT RESISTP
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS 87901
|
| Hospital Charge Code |
30001414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem Medicaid |
$257.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$257.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$360.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$257.45
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| 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 |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$308.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.62
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
OS HIV-1 RNA DETECT & QUANT P
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
30001381
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$501.88
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.75
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
OS HIV-1 RNA DETECT & QUANT P
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
30001381
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.06 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$114.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$75.28
|
| Rate for Payer: Healthspan PPO |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$218.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.06
|
|
|
OS HIV-1 RNA DETECT & QUANT P
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
30001381
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem Medicaid |
$85.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$85.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$501.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.10
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Humana KY Medicaid |
$85.10
|
| Rate for Payer: Humana Medicare Advantage |
$85.10
|
| Rate for Payer: Kentucky WC Medicaid |
$85.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$86.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.75
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
OS HIV1 RNA QUALITATIVE
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 87535
|
| Hospital Charge Code |
30001380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$218.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.05
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$235.72
|
| Rate for Payer: First Health Commercial |
$269.80
|
| Rate for Payer: Humana Commercial |
$241.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$209.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.92
|
| Rate for Payer: Ohio Health Group HMO |
$213.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.04
|
| Rate for Payer: PHCS Commercial |
$272.64
|
| Rate for Payer: United Healthcare All Payer |
$249.92
|
|
|
OS HIV1 RNA QUALITATIVE
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 87535
|
| Hospital Charge Code |
30001380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$218.68
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$235.72
|
| Rate for Payer: First Health Commercial |
$269.80
|
| Rate for Payer: Humana Commercial |
$241.40
|
| 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 |
$232.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$209.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.92
|
| Rate for Payer: Ohio Health Group HMO |
$213.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.04
|
| Rate for Payer: PHCS Commercial |
$272.64
|
| Rate for Payer: United Healthcare All Payer |
$249.92
|
|
|
OS HIV2 AB DIFFERENTIATION S
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
HCPCS 86702
|
| Hospital Charge Code |
30001180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.79 |
| Max. Negotiated Rate |
$367.68 |
| Rate for Payer: Aetna Commercial |
$294.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$307.55
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$317.89
|
| Rate for Payer: First Health Commercial |
$363.85
|
| Rate for Payer: Humana Commercial |
$325.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$314.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$282.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$337.04
|
| Rate for Payer: Ohio Health Group HMO |
$287.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.73
|
| Rate for Payer: PHCS Commercial |
$367.68
|
| Rate for Payer: United Healthcare All Payer |
$337.04
|
|
|
OS HIV2 AB DIFFERENTIATION S
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
HCPCS 86702
|
| Hospital Charge Code |
30001180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$367.68 |
| Rate for Payer: Aetna Commercial |
$294.91
|
| Rate for Payer: Anthem Medicaid |
$13.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$307.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.52
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$317.89
|
| Rate for Payer: First Health Commercial |
$363.85
|
| Rate for Payer: Humana Commercial |
$325.55
|
| Rate for Payer: Humana KY Medicaid |
$13.52
|
| Rate for Payer: Humana Medicare Advantage |
$13.52
|
| Rate for Payer: Kentucky WC Medicaid |
$13.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$314.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$282.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$337.04
|
| Rate for Payer: Ohio Health Group HMO |
$287.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.73
|
| Rate for Payer: PHCS Commercial |
$367.68
|
| Rate for Payer: United Healthcare All Payer |
$337.04
|
|
|
OS HLA B 15 02
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 81381
|
| Hospital Charge Code |
30000201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$237.86 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$169.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$169.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$237.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$169.90
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$169.90
|
| Rate for Payer: Humana Medicare Advantage |
$169.90
|
| Rate for Payer: Kentucky WC Medicaid |
$171.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$203.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS HLA B 15 02
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 81381
|
| Hospital Charge Code |
30000201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
