|
OS MANGANESE
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 83785
|
| Hospital Charge Code |
30000450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem Medicaid |
$26.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.65
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Humana KY Medicaid |
$26.65
|
| Rate for Payer: Humana Medicare Advantage |
$26.65
|
| Rate for Payer: Kentucky WC Medicaid |
$26.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
OS MANGO IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000853
|
|
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 MANGO IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000853
|
|
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 Marfan & Relat Genetic Pan
|
Facility
|
OP
|
$3,290.00
|
|
|
Service Code
|
HCPCS 81410
|
| Hospital Charge Code |
30001999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$427.70 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$2,533.30
|
| Rate for Payer: Anthem Medicaid |
$504.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$504.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,641.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$705.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$504.00
|
| Rate for Payer: Cash Price |
$1,645.00
|
| Rate for Payer: Cash Price |
$1,645.00
|
| Rate for Payer: Cigna Commercial |
$2,730.70
|
| Rate for Payer: First Health Commercial |
$3,125.50
|
| Rate for Payer: Humana Commercial |
$2,796.50
|
| Rate for Payer: Humana KY Medicaid |
$504.00
|
| Rate for Payer: Humana Medicare Advantage |
$504.00
|
| Rate for Payer: Kentucky WC Medicaid |
$509.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$514.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$658.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,019.90
|
| Rate for Payer: PHCS Commercial |
$3,158.40
|
| Rate for Payer: United Healthcare All Payer |
$2,895.20
|
|
|
OS Marfan & Relat Genetic Pan
|
Facility
|
IP
|
$3,290.00
|
|
|
Service Code
|
HCPCS 81410
|
| Hospital Charge Code |
30001999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$427.70 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$2,533.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,641.87
|
| Rate for Payer: Cash Price |
$1,645.00
|
| Rate for Payer: Cigna Commercial |
$2,730.70
|
| Rate for Payer: First Health Commercial |
$3,125.50
|
| Rate for Payer: Humana Commercial |
$2,796.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$658.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,019.90
|
| Rate for Payer: PHCS Commercial |
$3,158.40
|
| Rate for Payer: United Healthcare All Payer |
$2,895.20
|
|
|
OS MASS SPECTROMETRY
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30001861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem Medicaid |
$24.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.09
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Humana KY Medicaid |
$24.09
|
| Rate for Payer: Humana Medicare Advantage |
$24.09
|
| Rate for Payer: Kentucky WC Medicaid |
$24.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.81
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
OS MASS SPECTROMETRY
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30001861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.81
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
OS MASS SPECTROMETRY QUAL/QUAN
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
30002045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$305.28 |
| Rate for Payer: Aetna Commercial |
$244.86
|
| Rate for Payer: Anthem Medicaid |
$24.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.11
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$263.94
|
| Rate for Payer: First Health Commercial |
$302.10
|
| Rate for Payer: Humana Commercial |
$270.30
|
| Rate for Payer: Humana KY Medicaid |
$24.11
|
| Rate for Payer: Humana Medicare Advantage |
$24.11
|
| Rate for Payer: Kentucky WC Medicaid |
$24.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$260.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$234.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$279.84
|
| Rate for Payer: Ohio Health Group HMO |
$238.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$98.58
|
| Rate for Payer: PHCS Commercial |
$305.28
|
| Rate for Payer: United Healthcare All Payer |
$279.84
|
|
|
OS MASS SPECTROMETRY QUAL/QUAN
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
30002045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$305.28 |
| Rate for Payer: Aetna Commercial |
$244.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.35
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$263.94
|
| Rate for Payer: First Health Commercial |
$302.10
|
| Rate for Payer: Humana Commercial |
$270.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$260.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$234.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$279.84
|
| Rate for Payer: Ohio Health Group HMO |
$238.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$98.58
|
| Rate for Payer: PHCS Commercial |
$305.28
|
| Rate for Payer: United Healthcare All Payer |
$279.84
|
|
|
OS Mat21 FETAL CHROMO MICRODEL
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 81422
|
| Hospital Charge Code |
30001781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.91
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
OS Mat21 FETAL CHROMO MICRODEL
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 81422
|
| Hospital Charge Code |
30001781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$1,062.67 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem Medicaid |
$759.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,062.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.05
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Humana KY Medicaid |
$759.05
|
| Rate for Payer: Humana Medicare Advantage |
$759.05
|
| Rate for Payer: Kentucky WC Medicaid |
$766.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.91
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
OS MATERNIT21PRENATAL TEST
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$840.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$588.00
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.43
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30000210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$1,062.67 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$759.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,062.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.05
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$759.05
|
| Rate for Payer: Humana Medicare Advantage |
$759.05
|
| Rate for Payer: Kentucky WC Medicaid |
$766.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$1,062.67 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$759.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,062.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.05
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$759.05
|
| Rate for Payer: Humana Medicare Advantage |
$759.05
|
| Rate for Payer: Kentucky WC Medicaid |
$766.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.52
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
OS MATERNIT21PRENATAL TEST
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$840.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$588.00
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.43
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30000210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.52
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$1,062.67 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$759.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,062.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.05
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$759.05
|
| Rate for Payer: Humana Medicare Advantage |
$759.05
|
| Rate for Payer: Kentucky WC Medicaid |
$766.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
OS MATERNIT21PRENATAL TEST
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30000210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$840.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$588.00
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.43
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.52
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
OS MCOLN1 GENE
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 81290
|
| Hospital Charge Code |
30001917
|
|
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 MCOLN1 GENE
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 81290
|
| Hospital Charge Code |
30001917
|
|
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 MCR CORD DRUG PANEL
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001554
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| 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 |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.88
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS MCR CORD DRUG PANEL
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001554
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.88
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS MCR URINE COM DRUG SCREEN
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem Medicaid |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$190.07
|
| Rate for Payer: First Health Commercial |
$217.55
|
| Rate for Payer: Humana Commercial |
$194.65
|
| Rate for Payer: Humana KY Medicaid |
$62.14
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Kentucky WC Medicaid |
$62.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$187.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$201.52
|
| Rate for Payer: Ohio Health Group HMO |
$171.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.99
|
| Rate for Payer: PHCS Commercial |
$219.84
|
| Rate for Payer: United Healthcare All Payer |
$201.52
|
|
