|
OS LYME DISEASE AB CONF CSF
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$166.08 |
| Rate for Payer: Aetna Commercial |
$133.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.92
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$143.59
|
| Rate for Payer: First Health Commercial |
$164.35
|
| Rate for Payer: Humana Commercial |
$147.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$127.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$152.24
|
| Rate for Payer: Ohio Health Group HMO |
$129.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.63
|
| Rate for Payer: PHCS Commercial |
$166.08
|
| Rate for Payer: United Healthcare All Payer |
$152.24
|
|
|
OS LYME DISEASE AB CONF CSF
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$166.08 |
| Rate for Payer: Aetna Commercial |
$133.21
|
| Rate for Payer: Anthem Medicaid |
$15.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.49
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$143.59
|
| Rate for Payer: First Health Commercial |
$164.35
|
| Rate for Payer: Humana Commercial |
$147.05
|
| Rate for Payer: Humana KY Medicaid |
$15.49
|
| Rate for Payer: Humana Medicare Advantage |
$15.49
|
| Rate for Payer: Kentucky WC Medicaid |
$15.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$127.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$152.24
|
| Rate for Payer: Ohio Health Group HMO |
$129.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.63
|
| Rate for Payer: PHCS Commercial |
$166.08
|
| Rate for Payer: United Healthcare All Payer |
$152.24
|
|
|
OS LYME DISEASE AB IGG
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$15.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$41.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.49
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$15.49
|
| Rate for Payer: Humana Medicare Advantage |
$15.49
|
| Rate for Payer: Kentucky WC Medicaid |
$15.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
OS LYME DISEASE AB IGG
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$41.76
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
OS LYME DISEASE AB IGM
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$41.76
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
OS LYME DISEASE AB IGM
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$15.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$41.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.49
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$15.49
|
| Rate for Payer: Humana Medicare Advantage |
$15.49
|
| Rate for Payer: Kentucky WC Medicaid |
$15.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
OS LYME DISEASE CSF PCR
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
30001362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.48 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.29
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.76
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
OS LYME DISEASE CSF PCR
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
30001362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.76
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
OS LYME DISEASE CSF PCR
|
Professional
|
Both
|
$496.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
30001362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$496.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$297.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$347.20
|
| Rate for Payer: UHCCP Medicaid |
$173.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
OS LYME DISEASE PCR B
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
30001363
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
OS LYME DISEASE PCR B
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
30001363
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$499.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$499.00
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$299.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$349.30
|
| Rate for Payer: UHCCP Medicaid |
$174.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
OS LYME DISEASE PCR B
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
30001363
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.70
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
OS LYME DISEASE SEROLOGY S
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
30001122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$169.92 |
| Rate for Payer: Aetna Commercial |
$136.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.13
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cigna Commercial |
$146.91
|
| Rate for Payer: First Health Commercial |
$168.15
|
| Rate for Payer: Humana Commercial |
$150.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$155.76
|
| Rate for Payer: Ohio Health Group HMO |
$132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.87
|
| Rate for Payer: PHCS Commercial |
$169.92
|
| Rate for Payer: United Healthcare All Payer |
$155.76
|
|
|
OS LYME DISEASE SEROLOGY S
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
30001122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$169.92 |
| Rate for Payer: Aetna Commercial |
$136.29
|
| Rate for Payer: Anthem Medicaid |
$17.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.03
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cigna Commercial |
$146.91
|
| Rate for Payer: First Health Commercial |
$168.15
|
| Rate for Payer: Humana Commercial |
$150.45
|
| Rate for Payer: Humana KY Medicaid |
$17.03
|
| Rate for Payer: Humana Medicare Advantage |
$17.03
|
| Rate for Payer: Kentucky WC Medicaid |
$17.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$155.76
|
| Rate for Payer: Ohio Health Group HMO |
$132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.87
|
| Rate for Payer: PHCS Commercial |
$169.92
|
| Rate for Payer: United Healthcare All Payer |
$155.76
|
|
|
OS LYMPHOCYTE TRANSFORMATI0N 7
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
30001080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$49.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$68.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.03
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$49.03
|
| Rate for Payer: Humana Medicare Advantage |
$49.03
|
| Rate for Payer: Kentucky WC Medicaid |
$49.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
OS LYMPHOCYTE TRANSFORMATI0N 7
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
30001080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
OS LYMPHOCYTE TRANSFORMATION 1
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
30001081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
OS LYMPHOCYTE TRANSFORMATION 1
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
30001081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$49.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$68.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.03
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$49.03
|
| Rate for Payer: Humana Medicare Advantage |
$49.03
|
| Rate for Payer: Kentucky WC Medicaid |
$49.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
OS LYMPHOCYTE TRANSFORMATION 2
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
30001076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
OS LYMPHOCYTE TRANSFORMATION 2
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
30001076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$49.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$68.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.03
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$49.03
|
| Rate for Payer: Humana Medicare Advantage |
$49.03
|
| Rate for Payer: Kentucky WC Medicaid |
$49.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
OS LYMPHOCYTE TRANSFORMATION 3
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
30001078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$49.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$68.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.03
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$49.03
|
| Rate for Payer: Humana Medicare Advantage |
$49.03
|
| Rate for Payer: Kentucky WC Medicaid |
$49.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
OS LYMPHOCYTE TRANSFORMATION 3
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
30001078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
OS LYMPHOCYTE TRANSFORMATION 4
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
30001077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
OS LYMPHOCYTE TRANSFORMATION 4
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
30001077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$49.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$68.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.03
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$49.03
|
| Rate for Payer: Humana Medicare Advantage |
$49.03
|
| Rate for Payer: Kentucky WC Medicaid |
$49.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
OS LYMPHOCYTE TRANSFORMATION 5
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
30001083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
