|
OS BARTONELLA QUINTANA AB IGM
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
30001115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
OS BASIL IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS BASIL IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS BAY LEAF IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000674
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS BAY LEAF IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000674
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS B CELLS TOTAL COUNT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86355
|
| Hospital Charge Code |
30001084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$52.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.73
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$37.73
|
| Rate for Payer: Humana Medicare Advantage |
$37.73
|
| Rate for Payer: Kentucky WC Medicaid |
$38.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OS B CELLS TOTAL COUNT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86355
|
| Hospital Charge Code |
30001084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OS BCR/ABL1 GENE MINOR BP
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 81207
|
| Hospital Charge Code |
30001772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.31 |
| Max. Negotiated Rate |
$202.78 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$144.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$144.84
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Humana KY Medicaid |
$144.84
|
| Rate for Payer: Humana Medicare Advantage |
$144.84
|
| Rate for Payer: Kentucky WC Medicaid |
$146.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
OS BCR/ABL1 GENE MINOR BP
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 81207
|
| Hospital Charge Code |
30001772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
OS BCR/ABL1 GENE OTHER BP
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 81208
|
| Hospital Charge Code |
30001773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.70 |
| Max. Negotiated Rate |
$300.47 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$214.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$184.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.62
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$214.62
|
| Rate for Payer: Humana Medicare Advantage |
$214.62
|
| Rate for Payer: Kentucky WC Medicaid |
$216.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$218.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
OS BCR/ABL1 GENE OTHER BP
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 81208
|
| Hospital Charge Code |
30001773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$184.69
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
OS BCR/ABL1 MUTATION, SEQUENCI
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
HCPCS 81170
|
| Hospital Charge Code |
30002062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$177.90 |
| Max. Negotiated Rate |
$569.28 |
| Rate for Payer: Aetna Commercial |
$456.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.18
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Cigna Commercial |
$492.19
|
| Rate for Payer: First Health Commercial |
$563.35
|
| Rate for Payer: Humana Commercial |
$504.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$486.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$437.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$521.84
|
| Rate for Payer: Ohio Health Group HMO |
$444.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.17
|
| Rate for Payer: PHCS Commercial |
$569.28
|
| Rate for Payer: United Healthcare All Payer |
$521.84
|
|
|
OS BCR/ABL1 MUTATION, SEQUENCI
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
HCPCS 81170
|
| Hospital Charge Code |
30002062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$569.28 |
| Rate for Payer: Aetna Commercial |
$456.61
|
| Rate for Payer: Anthem Medicaid |
$300.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$300.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$420.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$300.00
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Cigna Commercial |
$492.19
|
| Rate for Payer: First Health Commercial |
$563.35
|
| Rate for Payer: Humana Commercial |
$504.05
|
| Rate for Payer: Humana KY Medicaid |
$300.00
|
| Rate for Payer: Humana Medicare Advantage |
$300.00
|
| Rate for Payer: Kentucky WC Medicaid |
$303.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$486.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$437.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$521.84
|
| Rate for Payer: Ohio Health Group HMO |
$444.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.17
|
| Rate for Payer: PHCS Commercial |
$569.28
|
| Rate for Payer: United Healthcare All Payer |
$521.84
|
|
|
OS BCR/ABL1 p190 GENE MINOR BP
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 81207
|
| Hospital Charge Code |
30001852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.84 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna Commercial |
$334.95
|
| Rate for Payer: Anthem Medicaid |
$144.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$349.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$144.84
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: First Health Commercial |
$413.25
|
| Rate for Payer: Humana Commercial |
$369.75
|
| Rate for Payer: Humana KY Medicaid |
$144.84
|
| Rate for Payer: Humana Medicare Advantage |
$144.84
|
| Rate for Payer: Kentucky WC Medicaid |
$146.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$356.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$382.80
|
| Rate for Payer: Ohio Health Group HMO |
$326.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$300.15
|
| Rate for Payer: PHCS Commercial |
$417.60
|
| Rate for Payer: United Healthcare All Payer |
$382.80
|
|
|
OS BCR/ABL1 p190 GENE MINOR BP
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 81207
|
| Hospital Charge Code |
30001852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna Commercial |
$334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$349.31
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: First Health Commercial |
$413.25
|
| Rate for Payer: Humana Commercial |
$369.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$356.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$382.80
|
| Rate for Payer: Ohio Health Group HMO |
$326.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$300.15
|
| Rate for Payer: PHCS Commercial |
$417.60
|
| Rate for Payer: United Healthcare All Payer |
$382.80
|
|
|
OS BCR/ABL P210 MC
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30002069
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$1,115.52 |
| Rate for Payer: Aetna Commercial |
$894.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.09
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$964.46
|
| Rate for Payer: First Health Commercial |
$1,103.90
|
| Rate for Payer: Humana Commercial |
$987.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$857.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,022.56
|
| Rate for Payer: Ohio Health Group HMO |
$871.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$929.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$801.78
|
| Rate for Payer: PHCS Commercial |
$1,115.52
|
| Rate for Payer: United Healthcare All Payer |
$1,022.56
|
|
|
OS BCR/ABL P210 MC
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30002069
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$1,115.52 |
| Rate for Payer: Aetna Commercial |
$894.74
|
| Rate for Payer: Anthem Medicaid |
$399.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.09
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$964.46
|
| Rate for Payer: First Health Commercial |
$1,103.90
|
| Rate for Payer: Humana Commercial |
$987.70
|
| Rate for Payer: Humana KY Medicaid |
$399.61
|
| Rate for Payer: Kentucky WC Medicaid |
$403.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$857.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$407.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,022.56
|
| Rate for Payer: Ohio Health Group HMO |
$871.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$929.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$801.78
|
| Rate for Payer: PHCS Commercial |
$1,115.52
|
| Rate for Payer: United Healthcare All Payer |
$1,022.56
|
|
|
OS BCR/ABL P210 QUNT MON CML
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
30000180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.70
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.92
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
OS BCR/ABL P210 QUNT MON CML
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
30000180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.96 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem Medicaid |
$163.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$163.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$229.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.96
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Humana KY Medicaid |
$163.96
|
| Rate for Payer: Humana Medicare Advantage |
$163.96
|
| Rate for Payer: Kentucky WC Medicaid |
$165.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.92
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
OS BCR/ABL P210 QUNT MON CML R
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
30002042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$163.96 |
| Max. Negotiated Rate |
$711.36 |
| Rate for Payer: Aetna Commercial |
$570.57
|
| Rate for Payer: Anthem Medicaid |
$163.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$163.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$229.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.96
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Cigna Commercial |
$615.03
|
| Rate for Payer: First Health Commercial |
$703.95
|
| Rate for Payer: Humana Commercial |
$629.85
|
| Rate for Payer: Humana KY Medicaid |
$163.96
|
| Rate for Payer: Humana Medicare Advantage |
$163.96
|
| Rate for Payer: Kentucky WC Medicaid |
$165.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$607.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$546.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.08
|
| Rate for Payer: Ohio Health Group HMO |
$555.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$592.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$644.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.29
|
| Rate for Payer: PHCS Commercial |
$711.36
|
| Rate for Payer: United Healthcare All Payer |
$652.08
|
|
|
OS BCR/ABL P210 QUNT MON CML R
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
30002042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$711.36 |
| Rate for Payer: Aetna Commercial |
$570.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.02
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Cigna Commercial |
$615.03
|
| Rate for Payer: First Health Commercial |
$703.95
|
| Rate for Payer: Humana Commercial |
$629.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$607.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$546.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.08
|
| Rate for Payer: Ohio Health Group HMO |
$555.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$592.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$644.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.29
|
| Rate for Payer: PHCS Commercial |
$711.36
|
| Rate for Payer: United Healthcare All Payer |
$652.08
|
|
|
OS BEEF IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS BEEF IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS BEETS (BEETROOT) IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000963
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS BEETS (BEETROOT) IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000963
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
