|
OS IGG SUBCLASSES 4
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000327
|
|
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 4
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000327
|
|
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 IGH GENE REARRANGE AMP METH
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS 81261
|
| Hospital Charge Code |
30001855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$394.56 |
| Rate for Payer: Aetna Commercial |
$316.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$330.03
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$341.13
|
| Rate for Payer: First Health Commercial |
$390.45
|
| Rate for Payer: Humana Commercial |
$349.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$303.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$361.68
|
| Rate for Payer: Ohio Health Group HMO |
$308.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.41
|
| Rate for Payer: PHCS Commercial |
$394.56
|
| Rate for Payer: United Healthcare All Payer |
$361.68
|
|
|
OS IGH GENE REARRANGE AMP METH
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS 81261
|
| Hospital Charge Code |
30001855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$394.56 |
| Rate for Payer: Aetna Commercial |
$316.47
|
| Rate for Payer: Anthem Medicaid |
$197.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$197.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$330.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$277.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$197.99
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$341.13
|
| Rate for Payer: First Health Commercial |
$390.45
|
| Rate for Payer: Humana Commercial |
$349.35
|
| Rate for Payer: Humana KY Medicaid |
$197.99
|
| Rate for Payer: Humana Medicare Advantage |
$197.99
|
| Rate for Payer: Kentucky WC Medicaid |
$199.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$303.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$361.68
|
| Rate for Payer: Ohio Health Group HMO |
$308.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.41
|
| Rate for Payer: PHCS Commercial |
$394.56
|
| Rate for Payer: United Healthcare All Payer |
$361.68
|
|
|
OS IGH VARI REGIONAL MUTATION
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
HCPCS 81263
|
| Hospital Charge Code |
30001883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.91 |
| Max. Negotiated Rate |
$966.72 |
| Rate for Payer: Aetna Commercial |
$775.39
|
| Rate for Payer: Anthem Medicaid |
$294.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$294.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$808.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$412.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$294.52
|
| Rate for Payer: Cash Price |
$503.50
|
| Rate for Payer: Cash Price |
$503.50
|
| Rate for Payer: Cigna Commercial |
$835.81
|
| Rate for Payer: First Health Commercial |
$956.65
|
| Rate for Payer: Humana Commercial |
$855.95
|
| Rate for Payer: Humana KY Medicaid |
$294.52
|
| Rate for Payer: Humana Medicare Advantage |
$294.52
|
| Rate for Payer: Kentucky WC Medicaid |
$297.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$825.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$743.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$353.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$300.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$886.16
|
| Rate for Payer: Ohio Health Group HMO |
$755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.17
|
| Rate for Payer: PHCS Commercial |
$966.72
|
| Rate for Payer: United Healthcare All Payer |
$886.16
|
|
|
OS IGH VARI REGIONAL MUTATION
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
HCPCS 81263
|
| Hospital Charge Code |
30001883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.91 |
| Max. Negotiated Rate |
$966.72 |
| Rate for Payer: Aetna Commercial |
$775.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$808.62
|
| Rate for Payer: Cash Price |
$503.50
|
| Rate for Payer: Cigna Commercial |
$835.81
|
| Rate for Payer: First Health Commercial |
$956.65
|
| Rate for Payer: Humana Commercial |
$855.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$825.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$743.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$886.16
|
| Rate for Payer: Ohio Health Group HMO |
$755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.17
|
| Rate for Payer: PHCS Commercial |
$966.72
|
| Rate for Payer: United Healthcare All Payer |
$886.16
|
|
|
OS IGK REARRANGEABN CLONAL POP
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS 81264
|
| Hospital Charge Code |
30001854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$394.56 |
| Rate for Payer: Aetna Commercial |
$316.47
|
| Rate for Payer: Anthem Medicaid |
$172.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$330.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.73
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$341.13
|
| Rate for Payer: First Health Commercial |
$390.45
|
| Rate for Payer: Humana Commercial |
$349.35
|
| Rate for Payer: Humana KY Medicaid |
$172.73
|
| Rate for Payer: Humana Medicare Advantage |
$172.73
|
| Rate for Payer: Kentucky WC Medicaid |
$174.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$303.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$361.68
|
| Rate for Payer: Ohio Health Group HMO |
$308.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.41
|
| Rate for Payer: PHCS Commercial |
$394.56
|
| Rate for Payer: United Healthcare All Payer |
$361.68
|
|
|
OS IGK REARRANGEABN CLONAL POP
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS 81264
|
| Hospital Charge Code |
30001854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$394.56 |
| Rate for Payer: Aetna Commercial |
$316.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$330.03
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$341.13
|
| Rate for Payer: First Health Commercial |
$390.45
|
| Rate for Payer: Humana Commercial |
$349.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$303.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$361.68
|
| Rate for Payer: Ohio Health Group HMO |
$308.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.41
|
| Rate for Payer: PHCS Commercial |
$394.56
|
| Rate for Payer: United Healthcare All Payer |
$361.68
|
|
|
OS IG PARAPROTEIN QUAL BLD/UR
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 0077U
|
| Hospital Charge Code |
30001944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem Medicaid |
$43.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$43.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$60.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.43
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Humana KY Medicaid |
$43.43
|
| Rate for Payer: Humana Medicare Advantage |
$43.43
|
| Rate for Payer: Kentucky WC Medicaid |
$43.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.73
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
OS IG PARAPROTEIN QUAL BLD/UR
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 0077U
|
| Hospital Charge Code |
30001944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.65
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.73
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
OS IHC MULTIPLEX
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
HCPCS 88344
|
| Hospital Charge Code |
30002004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$376.32 |
| Rate for Payer: Aetna Commercial |
$301.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$314.78
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cigna Commercial |
$325.36
|
| Rate for Payer: First Health Commercial |
$372.40
|
| Rate for Payer: Humana Commercial |
$333.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$321.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$289.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.96
|
| Rate for Payer: Ohio Health Group HMO |
$294.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.52
|
| Rate for Payer: PHCS Commercial |
$376.32
|
| Rate for Payer: United Healthcare All Payer |
$344.96
|
|
|
OS IHC MULTIPLEX
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
HCPCS 88344
|
| Hospital Charge Code |
30002004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$435.16 |
| Rate for Payer: Aetna Commercial |
$301.84
|
| Rate for Payer: Anthem Medicaid |
$134.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$310.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$314.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$435.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$419.62
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cigna Commercial |
$325.36
|
| Rate for Payer: First Health Commercial |
$372.40
|
| Rate for Payer: Humana Commercial |
$333.20
|
| Rate for Payer: Humana KY Medicaid |
$134.81
|
| Rate for Payer: Humana Medicare Advantage |
$310.83
|
| Rate for Payer: Kentucky WC Medicaid |
$136.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$321.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$289.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.96
|
| Rate for Payer: Ohio Health Group HMO |
$294.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.52
|
| Rate for Payer: PHCS Commercial |
$376.32
|
| Rate for Payer: United Healthcare All Payer |
$344.96
|
|
|
OS IKBKAP GENE
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 81260
|
| Hospital Charge Code |
30001916
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$55.03 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$39.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$55.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.31
|
| 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 |
$39.31
|
| Rate for Payer: Humana Medicare Advantage |
$39.31
|
| Rate for Payer: Kentucky WC Medicaid |
$39.70
|
| 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 |
$47.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.10
|
| 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 IKBKAP GENE
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 81260
|
| Hospital Charge Code |
30001916
|
|
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 IL28B POLYMORPHIS
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$435.84 |
| Rate for Payer: Aetna Commercial |
$349.58
|
| Rate for Payer: Anthem Medicaid |
$156.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.56
|
| Rate for Payer: Cash Price |
$227.00
|
| Rate for Payer: Cigna Commercial |
$376.82
|
| Rate for Payer: First Health Commercial |
$431.30
|
| Rate for Payer: Humana Commercial |
$385.90
|
| Rate for Payer: Humana KY Medicaid |
$156.13
|
| Rate for Payer: Kentucky WC Medicaid |
$157.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$372.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$399.52
|
| Rate for Payer: Ohio Health Group HMO |
$340.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.74
|
| Rate for Payer: PHCS Commercial |
$435.84
|
| Rate for Payer: United Healthcare All Payer |
$399.52
|
|
|
OS IL28B POLYMORPHIS
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$435.84 |
| Rate for Payer: Aetna Commercial |
$349.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.56
|
| Rate for Payer: Cash Price |
$227.00
|
| Rate for Payer: Cigna Commercial |
$376.82
|
| Rate for Payer: First Health Commercial |
$431.30
|
| Rate for Payer: Humana Commercial |
$385.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$372.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$399.52
|
| Rate for Payer: Ohio Health Group HMO |
$340.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.74
|
| Rate for Payer: PHCS Commercial |
$435.84
|
| Rate for Payer: United Healthcare All Payer |
$399.52
|
|
|
OS IMIPRAMINE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
OS IMIPRAMINE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
OS IMMUNE COMPLEX ASSAY
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 86332
|
| Hospital Charge Code |
30002058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$24.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.37
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$24.37
|
| Rate for Payer: Humana Medicare Advantage |
$24.37
|
| Rate for Payer: Kentucky WC Medicaid |
$24.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
OS IMMUNE COMPLEX ASSAY
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 86332
|
| Hospital Charge Code |
30002058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
OS IMMUNODIFFUSION OUCHTERLONY
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 86331
|
| Hospital Charge Code |
30001998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem Medicaid |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Humana KY Medicaid |
$11.98
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Kentucky WC Medicaid |
$12.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.75
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
OS IMMUNODIFFUSION OUCHTERLONY
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 86331
|
| Hospital Charge Code |
30001998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.08
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.75
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
OS IMMUNOELECTROPHORESISSERUM
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 86320
|
| Hospital Charge Code |
30001066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.40
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OS IMMUNOELECTROPHORESISSERUM
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 86320
|
| Hospital Charge Code |
30001066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$29.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.92
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Humana KY Medicaid |
$29.92
|
| Rate for Payer: Humana Medicare Advantage |
$29.92
|
| Rate for Payer: Kentucky WC Medicaid |
$30.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.40
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OS IMMUNOELECTROPHORESIS URINE
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 86325
|
| Hospital Charge Code |
30001067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem Medicaid |
$23.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.13
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Humana KY Medicaid |
$23.13
|
| Rate for Payer: Humana Medicare Advantage |
$23.13
|
| Rate for Payer: Kentucky WC Medicaid |
$23.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.16
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
