|
OS MH DRUG SCREEN TESTING MC (
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
30002049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.28 |
| Max. Negotiated Rate |
$341.76 |
| Rate for Payer: Aetna Commercial |
$274.12
|
| Rate for Payer: Anthem Medicaid |
$198.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$198.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$285.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$278.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.74
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cigna Commercial |
$295.48
|
| Rate for Payer: First Health Commercial |
$338.20
|
| Rate for Payer: Humana Commercial |
$302.60
|
| Rate for Payer: Humana KY Medicaid |
$198.74
|
| Rate for Payer: Humana Medicare Advantage |
$198.74
|
| Rate for Payer: Kentucky WC Medicaid |
$200.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$262.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$202.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$313.28
|
| Rate for Payer: Ohio Health Group HMO |
$267.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.36
|
| Rate for Payer: PHCS Commercial |
$341.76
|
| Rate for Payer: United Healthcare All Payer |
$313.28
|
|
|
OS MICROALBUMINU URINE QUA
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
30000228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.18
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.06
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
OS MICROALBUMINU URINE QUA
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
30000228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem Medicaid |
$5.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.78
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Humana KY Medicaid |
$5.78
|
| Rate for Payer: Humana Medicare Advantage |
$5.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.06
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
OS MICRODISSECTION LASER
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS 88380
|
| Hospital Charge Code |
30001860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.59 |
| Max. Negotiated Rate |
$1,289.28 |
| Rate for Payer: Aetna Commercial |
$1,034.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,078.43
|
| Rate for Payer: Cash Price |
$671.50
|
| Rate for Payer: Cigna Commercial |
$1,114.69
|
| Rate for Payer: First Health Commercial |
$1,275.85
|
| Rate for Payer: Humana Commercial |
$1,141.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,101.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$991.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,181.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,007.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$416.33
|
| Rate for Payer: PHCS Commercial |
$1,289.28
|
| Rate for Payer: United Healthcare All Payer |
$1,181.84
|
|
|
OS MICRODISSECTION LASER
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS 88380
|
| Hospital Charge Code |
30001860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.59 |
| Max. Negotiated Rate |
$1,289.28 |
| Rate for Payer: Aetna Commercial |
$1,034.11
|
| Rate for Payer: Anthem Medicaid |
$461.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,078.43
|
| Rate for Payer: Cash Price |
$671.50
|
| Rate for Payer: Cigna Commercial |
$1,114.69
|
| Rate for Payer: First Health Commercial |
$1,275.85
|
| Rate for Payer: Humana Commercial |
$1,141.55
|
| Rate for Payer: Humana KY Medicaid |
$461.86
|
| Rate for Payer: Kentucky WC Medicaid |
$466.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,101.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$991.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$471.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,181.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,007.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$416.33
|
| Rate for Payer: PHCS Commercial |
$1,289.28
|
| Rate for Payer: United Healthcare All Payer |
$1,181.84
|
|
|
OS MICRODISSECTION MANUAL
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS 88381
|
| Hospital Charge Code |
30001993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$177.46
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cigna Commercial |
$183.43
|
| Rate for Payer: First Health Commercial |
$209.95
|
| Rate for Payer: Humana Commercial |
$187.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$181.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$194.48
|
| Rate for Payer: Ohio Health Group HMO |
$165.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.51
|
| Rate for Payer: PHCS Commercial |
$212.16
|
| Rate for Payer: United Healthcare All Payer |
$194.48
|
|
|
OS MICRODISSECTION MANUAL
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 88381
|
| Hospital Charge Code |
30001993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Anthem Medicaid |
$76.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$177.46
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cigna Commercial |
$183.43
|
| Rate for Payer: First Health Commercial |
$209.95
|
| Rate for Payer: Humana Commercial |
$187.85
|
| Rate for Payer: Humana KY Medicaid |
$76.00
|
| Rate for Payer: Kentucky WC Medicaid |
$76.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$181.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$194.48
|
| Rate for Payer: Ohio Health Group HMO |
$165.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.51
|
| Rate for Payer: PHCS Commercial |
$212.16
|
| Rate for Payer: United Healthcare All Payer |
$194.48
|
|
|
OS MICROSLIDE CONSULTATION
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
30001517
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$498.24 |
| Rate for Payer: Aetna Commercial |
$399.63
|
| Rate for Payer: Anthem Medicaid |
$178.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$430.77
|
| Rate for Payer: First Health Commercial |
$493.05
|
| Rate for Payer: Humana Commercial |
$441.15
|
| Rate for Payer: Humana KY Medicaid |
$178.48
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$180.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$425.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$456.72
|
| Rate for Payer: Ohio Health Group HMO |
$389.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.89
|
| Rate for Payer: PHCS Commercial |
$498.24
|
| Rate for Payer: United Healthcare All Payer |
$456.72
|
|
|
OS MICROSLIDE CONSULTATION
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
30001517
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$498.24 |
| Rate for Payer: Aetna Commercial |
$399.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.76
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$430.77
|
| Rate for Payer: First Health Commercial |
$493.05
|
| Rate for Payer: Humana Commercial |
$441.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$425.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$456.72
|
| Rate for Payer: Ohio Health Group HMO |
$389.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.89
|
| Rate for Payer: PHCS Commercial |
$498.24
|
| Rate for Payer: United Healthcare All Payer |
$456.72
|
|
|
OS MICROSOMAL ANTI
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001088
|
|
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
|
|
|
OS MICROSOMAL ANTI
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001088
|
|
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 MICROSOMAL ANTIBODY EACH
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
OS MICROSOMAL ANTIBODY EACH
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem Medicaid |
$14.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| 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 |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
OS MILK GOAT IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000777
|
|
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 MILK GOAT IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000777
|
|
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 MILK PROCESSED IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000742
|
|
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 MILK PROCESSED IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000742
|
|
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 MILLENNIUM DRUG TESTING
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$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 |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS MILLENNIUM DRUG TESTING
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
OS MILLENNIUM DRUG TESTING MC
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
30001557
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$452.89
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.84
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
OS MILLENNIUM DRUG TESTING MC
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
30001557
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem Medicaid |
$246.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$246.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$452.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$345.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$246.92
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Humana KY Medicaid |
$246.92
|
| Rate for Payer: Humana Medicare Advantage |
$246.92
|
| Rate for Payer: Kentucky WC Medicaid |
$249.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$296.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$251.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.84
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
OS MITOCHONDRIAL AB M2 S
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 86381
|
| Hospital Charge Code |
30000382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$25.45
|
| Rate for Payer: Humana Medicare Advantage |
$25.45
|
| Rate for Payer: Kentucky WC Medicaid |
$25.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
OS MITOCHONDRIAL AB M2 S
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 86381
|
| Hospital Charge Code |
30000382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.71
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
OS MITOCHONDRIAL AB SCREEN
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.40
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OS MITOCHONDRIAL AB SCREEN
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.40
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
