|
OS HTT GENE DETC ABNOR ALLELES
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS 81271
|
| Hospital Charge Code |
30001878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: Anthem Medicaid |
$137.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$191.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.00
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$336.15
|
| Rate for Payer: First Health Commercial |
$384.75
|
| Rate for Payer: Humana Commercial |
$344.25
|
| Rate for Payer: Humana KY Medicaid |
$137.00
|
| Rate for Payer: Humana Medicare Advantage |
$137.00
|
| Rate for Payer: Kentucky WC Medicaid |
$138.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
| Rate for Payer: Ohio Health Group HMO |
$303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.55
|
| Rate for Payer: PHCS Commercial |
$388.80
|
| Rate for Payer: United Healthcare All Payer |
$356.40
|
|
|
OS HUMAN EPIDIDYMIS PROTEIN 4
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 86305
|
| Hospital Charge Code |
30001850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem Medicaid |
$20.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Humana KY Medicaid |
$20.81
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Kentucky WC Medicaid |
$21.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
OS HUMAN EPIDIDYMIS PROTEIN 4
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 86305
|
| Hospital Charge Code |
30001850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
OS IA-2 AB S
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
30001073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$133.44 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$111.62
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.09
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
|
OS IA-2 AB S
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
30001073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$133.44 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem Medicaid |
$23.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$111.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.57
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Humana KY Medicaid |
$23.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.57
|
| Rate for Payer: Kentucky WC Medicaid |
$23.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.09
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
|
OS ICAM
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000275
|
|
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 ICAM
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000275
|
|
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 Medicaid |
$14.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.12
|
| 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 |
$14.12
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$14.26
|
| 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 |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$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 IgA, IgD, IgG, or IgM each
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
30000324
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$12.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$8.16
|
| Rate for Payer: Healthspan PPO |
$9.74
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.58
|
|
|
OS IgA, IgD, IgG, or IgM each
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
30000324
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem Medicaid |
$9.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.30
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Humana KY Medicaid |
$9.30
|
| Rate for Payer: Humana Medicare Advantage |
$9.30
|
| Rate for Payer: Kentucky WC Medicaid |
$9.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.75
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
OS IgA, IgD, IgG, or IgM each
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
30000324
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.68
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.75
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
OS IGA SUBCLASSES 1
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$8.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.02
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$8.02
|
| Rate for Payer: Humana Medicare Advantage |
$8.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS IGA SUBCLASSES 1
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS IGA SUBCLASSES 2
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS IGA SUBCLASSES 2
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$8.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.02
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$8.02
|
| Rate for Payer: Humana Medicare Advantage |
$8.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS IGE TOTAL
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
30000326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS IGE TOTAL
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
30000326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$16.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.46
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$16.46
|
| Rate for Payer: Humana Medicare Advantage |
$16.46
|
| Rate for Payer: Kentucky WC Medicaid |
$16.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS IGFBP 3 SERUM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.51
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.70
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
OS IGFBP 3 SERUM
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna Commercial |
$30.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$170.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$11.52
|
| Rate for Payer: Healthspan PPO |
$13.57
|
| Rate for Payer: Multiplan PHCS |
$102.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.00
|
| Rate for Payer: UHCCP Medicaid |
$59.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.36
|
|
|
OS IGFBP 3 SERUM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.70
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
OS IGG SUBCLASSES 1
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS IGG SUBCLASSES 1
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$8.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.02
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$8.02
|
| Rate for Payer: Humana Medicare Advantage |
$8.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS IGG SUBCLASSES 2
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$8.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.02
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$8.02
|
| Rate for Payer: Humana Medicare Advantage |
$8.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS IGG SUBCLASSES 2
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS IGG SUBCLASSES 3
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000330
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$8.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.02
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$8.02
|
| Rate for Payer: Humana Medicare Advantage |
$8.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS IGG SUBCLASSES 3
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000330
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
