|
OS HLA-B27 SINGLE ANTGEN
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 86812
|
| Hospital Charge Code |
30001224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$237.12 |
| Rate for Payer: Aetna Commercial |
$190.19
|
| Rate for Payer: Anthem Medicaid |
$25.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$198.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.81
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cigna Commercial |
$205.01
|
| Rate for Payer: First Health Commercial |
$234.65
|
| Rate for Payer: Humana Commercial |
$209.95
|
| Rate for Payer: Humana KY Medicaid |
$25.81
|
| Rate for Payer: Humana Medicare Advantage |
$25.81
|
| Rate for Payer: Kentucky WC Medicaid |
$26.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$202.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$182.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$217.36
|
| Rate for Payer: Ohio Health Group HMO |
$185.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.57
|
| Rate for Payer: PHCS Commercial |
$237.12
|
| Rate for Payer: United Healthcare All Payer |
$217.36
|
|
|
OS HLA-B27 SINGLE ANTGEN
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 86812
|
| Hospital Charge Code |
30001224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$237.12 |
| Rate for Payer: Aetna Commercial |
$190.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$198.34
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cigna Commercial |
$205.01
|
| Rate for Payer: First Health Commercial |
$234.65
|
| Rate for Payer: Humana Commercial |
$209.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$202.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$182.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$217.36
|
| Rate for Payer: Ohio Health Group HMO |
$185.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.57
|
| Rate for Payer: PHCS Commercial |
$237.12
|
| Rate for Payer: United Healthcare All Payer |
$217.36
|
|
|
OS HLA CLASS 1 MOL PHENOTYPE B
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 81372
|
| Hospital Charge Code |
30000199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.35
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.96
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
OS HLA CLASS 1 MOL PHENOTYPE B
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 81372
|
| Hospital Charge Code |
30000199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$565.03 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem Medicaid |
$403.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$403.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$565.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$403.59
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Humana KY Medicaid |
$403.59
|
| Rate for Payer: Humana Medicare Advantage |
$403.59
|
| Rate for Payer: Kentucky WC Medicaid |
$407.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.96
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
OS HLA CLASS II TYP BY PCR
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 81375
|
| Hospital Charge Code |
30000200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem Medicaid |
$220.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$220.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$309.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$220.74
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Humana KY Medicaid |
$220.74
|
| Rate for Payer: Humana Medicare Advantage |
$220.74
|
| Rate for Payer: Kentucky WC Medicaid |
$222.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$225.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.96
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
OS HLA CLASS II TYP BY PCR
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 81375
|
| Hospital Charge Code |
30000200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.35
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.96
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
OS HLA DQA1
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS 81382
|
| Hospital Charge Code |
30000202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem Medicaid |
$123.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$123.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$173.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.68
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Humana KY Medicaid |
$123.68
|
| Rate for Payer: Humana Medicare Advantage |
$123.68
|
| Rate for Payer: Kentucky WC Medicaid |
$124.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.56
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS HLA DQA1
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS 81382
|
| Hospital Charge Code |
30000202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.56
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS HLA DQA2
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS 81382
|
| Hospital Charge Code |
30000203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem Medicaid |
$123.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$123.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$173.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.68
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Humana KY Medicaid |
$123.68
|
| Rate for Payer: Humana Medicare Advantage |
$123.68
|
| Rate for Payer: Kentucky WC Medicaid |
$124.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.56
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS HLA DQA2
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS 81382
|
| Hospital Charge Code |
30000203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.56
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS HLA II TYPING 1 LOCUS LR
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 81376
|
| Hospital Charge Code |
30001839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: Aetna Commercial |
$157.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.81
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$169.32
|
| Rate for Payer: First Health Commercial |
$193.80
|
| Rate for Payer: Humana Commercial |
$173.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.52
|
| Rate for Payer: Ohio Health Group HMO |
$153.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.24
|
| Rate for Payer: PHCS Commercial |
$195.84
|
| Rate for Payer: United Healthcare All Payer |
$179.52
|
|
|
OS HLA II TYPING 1 LOCUS LR
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 81376
|
| Hospital Charge Code |
30001839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: Aetna Commercial |
$157.08
|
| Rate for Payer: Anthem Medicaid |
$122.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.22
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$169.32
|
| Rate for Payer: First Health Commercial |
$193.80
|
| Rate for Payer: Humana Commercial |
$173.40
|
| Rate for Payer: Humana KY Medicaid |
$122.22
|
| Rate for Payer: Humana Medicare Advantage |
$122.22
|
| Rate for Payer: Kentucky WC Medicaid |
$123.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.52
|
| Rate for Payer: Ohio Health Group HMO |
$153.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.24
|
| Rate for Payer: PHCS Commercial |
$195.84
|
| Rate for Payer: United Healthcare All Payer |
$179.52
|
|
|
OS HOLLISTER HOUSE DUST IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000786
|
|
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 HOLLISTER HOUSE DUST IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000786
|
|
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 HOMOCYSTEINE
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
30000369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: Aetna Commercial |
$157.08
|
| Rate for Payer: Anthem Medicaid |
$17.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.92
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$169.32
|
| Rate for Payer: First Health Commercial |
$193.80
|
| Rate for Payer: Humana Commercial |
$173.40
|
| Rate for Payer: Humana KY Medicaid |
$17.92
|
| Rate for Payer: Humana Medicare Advantage |
$17.92
|
| Rate for Payer: Kentucky WC Medicaid |
$18.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.52
|
| Rate for Payer: Ohio Health Group HMO |
$153.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.24
|
| Rate for Payer: PHCS Commercial |
$195.84
|
| Rate for Payer: United Healthcare All Payer |
$179.52
|
|
|
OS HOMOCYSTEINE
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
30000369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: Aetna Commercial |
$157.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.81
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$169.32
|
| Rate for Payer: First Health Commercial |
$193.80
|
| Rate for Payer: Humana Commercial |
$173.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.52
|
| Rate for Payer: Ohio Health Group HMO |
$153.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.24
|
| Rate for Payer: PHCS Commercial |
$195.84
|
| Rate for Payer: United Healthcare All Payer |
$179.52
|
|
|
OS HOMOVANILLIC ACID (HVA) U
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
30000370
|
|
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 HOMOVANILLIC ACID (HVA) U
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
30000370
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem Medicaid |
$22.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.41
|
| 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 |
$22.41
|
| Rate for Payer: Humana Medicare Advantage |
$22.41
|
| Rate for Payer: Kentucky WC Medicaid |
$22.63
|
| 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 |
$26.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.86
|
| 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 HONEYBEE VENOM IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000661
|
|
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 HONEYBEE VENOM IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000661
|
|
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 HONEY IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000753
|
|
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 HONEY IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000753
|
|
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 HORN BEAN IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000663
|
|
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 HORN BEAN IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000663
|
|
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 HORSE DANDER IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000863
|
|
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
|
|
