|
OS LEGIONELL PNEUMONPHILIA AB
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
HCPCS 86713
|
| Hospital Charge Code |
30001192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$161.28 |
| Rate for Payer: Aetna Commercial |
$129.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.90
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$139.44
|
| Rate for Payer: First Health Commercial |
$159.60
|
| Rate for Payer: Humana Commercial |
$142.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.84
|
| Rate for Payer: Ohio Health Group HMO |
$126.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.08
|
| Rate for Payer: PHCS Commercial |
$161.28
|
| Rate for Payer: United Healthcare All Payer |
$147.84
|
|
|
OS LEPTOSPIRA ANTIBODY
|
Facility
|
IP
|
$211.51
|
|
|
Service Code
|
HCPCS 86720
|
| Hospital Charge Code |
30002050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$203.05 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$169.84
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna Commercial |
$175.55
|
| Rate for Payer: First Health Commercial |
$200.93
|
| Rate for Payer: Humana Commercial |
$179.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.13
|
| Rate for Payer: Ohio Health Group HMO |
$158.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.57
|
| Rate for Payer: PHCS Commercial |
$203.05
|
| Rate for Payer: United Healthcare All Payer |
$186.13
|
|
|
OS LEPTOSPIRA ANTIBODY
|
Facility
|
OP
|
$211.51
|
|
|
Service Code
|
HCPCS 86720
|
| Hospital Charge Code |
30002050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$203.05 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Anthem Medicaid |
$16.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$169.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.20
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna Commercial |
$175.55
|
| Rate for Payer: First Health Commercial |
$200.93
|
| Rate for Payer: Humana Commercial |
$179.78
|
| Rate for Payer: Humana KY Medicaid |
$16.20
|
| Rate for Payer: Humana Medicare Advantage |
$16.20
|
| Rate for Payer: Kentucky WC Medicaid |
$16.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.13
|
| Rate for Payer: Ohio Health Group HMO |
$158.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.57
|
| Rate for Payer: PHCS Commercial |
$203.05
|
| Rate for Payer: United Healthcare All Payer |
$186.13
|
|
|
OS LEUKOCYTE HISTAMINE RELEASE
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 86343
|
| Hospital Charge Code |
30001931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem Medicaid |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.46
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| Rate for Payer: Humana KY Medicaid |
$12.46
|
| Rate for Payer: Humana Medicare Advantage |
$12.46
|
| Rate for Payer: Kentucky WC Medicaid |
$12.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.36
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
OS LEUKOCYTE HISTAMINE RELEASE
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 86343
|
| Hospital Charge Code |
30001931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.57
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.36
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
OS LEVEL 5 PATHOLOGY
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 81404
|
| Hospital Charge Code |
30000208
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$384.76 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$274.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$274.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$384.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$274.83
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$274.83
|
| Rate for Payer: Humana Medicare Advantage |
$274.83
|
| Rate for Payer: Kentucky WC Medicaid |
$277.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
OS LEVEL 5 PATHOLOGY
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 81404
|
| Hospital Charge Code |
30000208
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.74
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
OS LEVEL 6 PATHOLOGY
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 81405
|
| Hospital Charge Code |
30000209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$421.89 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$301.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$301.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$421.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.35
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$301.35
|
| Rate for Payer: Humana Medicare Advantage |
$301.35
|
| Rate for Payer: Kentucky WC Medicaid |
$304.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$307.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
OS LEVEL 6 PATHOLOGY
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 81405
|
| Hospital Charge Code |
30000209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.74
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
OS LEVETIRACETAM S
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
30000036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.25
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.27
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
OS LEVETIRACETAM S
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
30000036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.27
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
OS LIDOCAINE PLASMA
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 80176
|
| Hospital Charge Code |
30000035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna Commercial |
$75.46
|
| Rate for Payer: Anthem Medicaid |
$14.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.69
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$81.34
|
| Rate for Payer: First Health Commercial |
$93.10
|
| Rate for Payer: Humana Commercial |
$83.30
|
| Rate for Payer: Humana KY Medicaid |
$14.69
|
| Rate for Payer: Humana Medicare Advantage |
$14.69
|
| Rate for Payer: Kentucky WC Medicaid |
$14.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.24
|
| Rate for Payer: Ohio Health Group HMO |
$73.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.38
|
| Rate for Payer: PHCS Commercial |
$94.08
|
| Rate for Payer: United Healthcare All Payer |
$86.24
|
|
|
OS LIDOCAINE PLASMA
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 80176
|
| Hospital Charge Code |
30000035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna Commercial |
$75.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.69
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$81.34
|
| Rate for Payer: First Health Commercial |
$93.10
|
| Rate for Payer: Humana Commercial |
$83.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.24
|
| Rate for Payer: Ohio Health Group HMO |
$73.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.38
|
| Rate for Payer: PHCS Commercial |
$94.08
|
| Rate for Payer: United Healthcare All Payer |
$86.24
|
|
|
OS LIPID PANEL
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.57
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
|
OS LIPID PANEL
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem Medicaid |
$13.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Humana KY Medicaid |
$13.39
|
| Rate for Payer: Humana Medicare Advantage |
$13.39
|
| Rate for Payer: Kentucky WC Medicaid |
$13.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.57
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
|
OS LIPOPROTEIN A SERUM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 83695
|
| Hospital Charge Code |
30000421
|
|
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 LIPOPROTEIN A SERUM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 83695
|
| Hospital Charge Code |
30000421
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem Medicaid |
$14.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.32
|
| 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 |
$14.32
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$14.46
|
| 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 |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.61
|
| 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 LIPOPROTEIN PLA2
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 83698
|
| Hospital Charge Code |
30001950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$64.83 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$46.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$64.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.31
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$46.31
|
| Rate for Payer: Humana Medicare Advantage |
$46.31
|
| Rate for Payer: Kentucky WC Medicaid |
$46.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
OS LIPOPROTEIN PLA2
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 83698
|
| Hospital Charge Code |
30001950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
OS LSD CONFIRMATION URINE
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS LSD CONFIRMATION URINE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| 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 |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS LUPINE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000788
|
|
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 LUPINE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000788
|
|
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 LVER/KDNEY MICROS TYP 1 AB
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$14.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$14.55
|
| Rate for Payer: Humana Medicare Advantage |
$14.55
|
| Rate for Payer: Kentucky WC Medicaid |
$14.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
OS LVER/KDNEY MICROS TYP 1 AB
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.56
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
