|
OS MOPATH PROCEDURE LEVEL 1
|
Facility
|
IP
|
$548.70
|
|
|
Service Code
|
HCPCS 81400
|
| Hospital Charge Code |
30002018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.33 |
| Max. Negotiated Rate |
$526.75 |
| Rate for Payer: Aetna Commercial |
$422.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.61
|
| Rate for Payer: Cash Price |
$274.35
|
| Rate for Payer: Cigna Commercial |
$455.42
|
| Rate for Payer: First Health Commercial |
$521.26
|
| Rate for Payer: Humana Commercial |
$466.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.86
|
| Rate for Payer: Ohio Health Group HMO |
$411.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.10
|
| Rate for Payer: PHCS Commercial |
$526.75
|
| Rate for Payer: United Healthcare All Payer |
$482.86
|
|
|
OS MORPHINE UNCONJUGATED S
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| 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 |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.84
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
OS MORPHINE UNCONJUGATED S
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.84
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
OS MOSQUITO SPECIES IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000824
|
|
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 MOSQUITO SPECIES IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000824
|
|
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 MOTH IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000828
|
|
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 MOTH IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000828
|
|
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 MOUNTAIN CEDAR IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000951
|
|
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 MOUNTAIN CEDAR IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000951
|
|
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 M/PHMTRC ALYS ISHQUANT/SEMI
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
HCPCS 88377
|
| Hospital Charge Code |
30001847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.47 |
| Max. Negotiated Rate |
$882.24 |
| Rate for Payer: Aetna Commercial |
$707.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.96
|
| Rate for Payer: Cash Price |
$459.50
|
| Rate for Payer: Cigna Commercial |
$762.77
|
| Rate for Payer: First Health Commercial |
$873.05
|
| Rate for Payer: Humana Commercial |
$781.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$753.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$678.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$275.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$808.72
|
| Rate for Payer: Ohio Health Group HMO |
$689.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.89
|
| Rate for Payer: PHCS Commercial |
$882.24
|
| Rate for Payer: United Healthcare All Payer |
$808.72
|
|
|
OS M/PHMTRC ALYS ISHQUANT/SEMI
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
HCPCS 88377
|
| Hospital Charge Code |
30001847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.47 |
| Max. Negotiated Rate |
$882.24 |
| Rate for Payer: Aetna Commercial |
$707.63
|
| Rate for Payer: Anthem Medicaid |
$316.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$459.50
|
| Rate for Payer: Cash Price |
$459.50
|
| Rate for Payer: Cigna Commercial |
$762.77
|
| Rate for Payer: First Health Commercial |
$873.05
|
| Rate for Payer: Humana Commercial |
$781.15
|
| Rate for Payer: Humana KY Medicaid |
$316.04
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$319.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$753.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$678.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$322.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$808.72
|
| Rate for Payer: Ohio Health Group HMO |
$689.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.89
|
| Rate for Payer: PHCS Commercial |
$882.24
|
| Rate for Payer: United Healthcare All Payer |
$808.72
|
|
|
OS MPL EXON10 MUTATION DETECT
|
Facility
|
OP
|
$1,045.00
|
|
|
Service Code
|
HCPCS 81339
|
| Hospital Charge Code |
30000207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$1,003.20 |
| Rate for Payer: Aetna Commercial |
$804.65
|
| Rate for Payer: Anthem Medicaid |
$185.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$839.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$259.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.20
|
| Rate for Payer: Cash Price |
$522.50
|
| Rate for Payer: Cash Price |
$522.50
|
| Rate for Payer: Cigna Commercial |
$867.35
|
| Rate for Payer: First Health Commercial |
$992.75
|
| Rate for Payer: Humana Commercial |
$888.25
|
| Rate for Payer: Humana KY Medicaid |
$185.20
|
| Rate for Payer: Humana Medicare Advantage |
$185.20
|
| Rate for Payer: Kentucky WC Medicaid |
$187.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$856.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$771.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$919.60
|
| Rate for Payer: Ohio Health Group HMO |
$783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$209.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$323.95
|
| Rate for Payer: PHCS Commercial |
$1,003.20
|
| Rate for Payer: United Healthcare All Payer |
$919.60
|
|
|
OS MPL EXON10 MUTATION DETECT
|
Facility
|
IP
|
$1,045.00
|
|
|
Service Code
|
HCPCS 81339
|
| Hospital Charge Code |
30000207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$1,003.20 |
| Rate for Payer: Aetna Commercial |
$804.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$839.14
|
| Rate for Payer: Cash Price |
$522.50
|
| Rate for Payer: Cigna Commercial |
$867.35
|
| Rate for Payer: First Health Commercial |
$992.75
|
| Rate for Payer: Humana Commercial |
$888.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$856.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$771.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$313.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$919.60
|
| Rate for Payer: Ohio Health Group HMO |
$783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$209.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$323.95
|
| Rate for Payer: PHCS Commercial |
$1,003.20
|
| Rate for Payer: United Healthcare All Payer |
$919.60
|
|
|
OS MTHFR ANTIDEPRESSANT
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
30000193
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS MTHFR ANTIDEPRESSANT
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
30000193
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$65.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$91.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.34
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$65.34
|
| Rate for Payer: Humana Medicare Advantage |
$65.34
|
| Rate for Payer: Kentucky WC Medicaid |
$65.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS M.TUBERCULO DNA AMP PROBE
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
30001964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem Medicaid |
$41.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$58.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.68
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Humana KY Medicaid |
$41.68
|
| Rate for Payer: Humana Medicare Advantage |
$41.68
|
| Rate for Payer: Kentucky WC Medicaid |
$42.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.35
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
OS M.TUBERCULO DNA AMP PROBE
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
30001964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.86
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.35
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
OS MUCOR IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000759
|
|
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 MUCOR IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000759
|
|
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 MULBERRY IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000808
|
|
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 MULBERRY IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000808
|
|
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 MUMPS SCREEN
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
30001195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$328.32 |
| Rate for Payer: Aetna Commercial |
$263.34
|
| Rate for Payer: Anthem Medicaid |
$13.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.05
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$283.86
|
| Rate for Payer: First Health Commercial |
$324.90
|
| Rate for Payer: Humana Commercial |
$290.70
|
| Rate for Payer: Humana KY Medicaid |
$13.05
|
| Rate for Payer: Humana Medicare Advantage |
$13.05
|
| Rate for Payer: Kentucky WC Medicaid |
$13.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$280.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$252.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.96
|
| Rate for Payer: Ohio Health Group HMO |
$256.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.02
|
| Rate for Payer: PHCS Commercial |
$328.32
|
| Rate for Payer: United Healthcare All Payer |
$300.96
|
|
|
OS MUMPS SCREEN
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
30001195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$328.32 |
| Rate for Payer: Aetna Commercial |
$263.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.63
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$283.86
|
| Rate for Payer: First Health Commercial |
$324.90
|
| Rate for Payer: Humana Commercial |
$290.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$280.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$252.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.96
|
| Rate for Payer: Ohio Health Group HMO |
$256.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.02
|
| Rate for Payer: PHCS Commercial |
$328.32
|
| Rate for Payer: United Healthcare All Payer |
$300.96
|
|
|
OS MUSCLE RELAXANTS URINE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80370
|
| Hospital Charge Code |
30000166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$26.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Multiplan PHCS |
$15.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.20
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
|
|
OS MUSCLE RELAXANTS URINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
