|
OS PARVOVIRUS B19 AB IGM S
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
30001198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.98
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
OS PARVOVIRUS B19 AB IGM S
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
30001198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem Medicaid |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.03
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Humana KY Medicaid |
$15.03
|
| Rate for Payer: Humana Medicare Advantage |
$15.03
|
| Rate for Payer: Kentucky WC Medicaid |
$15.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
OS PARVOVIRUS B19 PCR
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001399
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.88
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS PARVOVIRUS B19 PCR
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001399
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.88
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS PASSION FRUIT IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000812
|
|
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 PASSION FRUIT IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000812
|
|
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 PATHOLOGY CONSULT
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30001519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna Commercial |
$374.22
|
| Rate for Payer: Anthem Medicaid |
$167.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$403.38
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Humana Commercial |
$413.10
|
| Rate for Payer: Humana KY Medicaid |
$167.14
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$168.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$358.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$170.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$427.68
|
| Rate for Payer: Ohio Health Group HMO |
$364.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.66
|
| Rate for Payer: PHCS Commercial |
$466.56
|
| Rate for Payer: United Healthcare All Payer |
$427.68
|
|
|
OS PATHOLOGY CONSULT
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30001519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna Commercial |
$374.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.26
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$403.38
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Humana Commercial |
$413.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$358.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$427.68
|
| Rate for Payer: Ohio Health Group HMO |
$364.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.66
|
| Rate for Payer: PHCS Commercial |
$466.56
|
| Rate for Payer: United Healthcare All Payer |
$427.68
|
|
|
OS PATH PROCEDURE LEVEL 6
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 81405
|
| Hospital Charge Code |
30001884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.55
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
OS PATH PROCEDURE LEVEL 6
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 81405
|
| Hospital Charge Code |
30001884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$301.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$301.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$421.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.35
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$301.35
|
| Rate for Payer: Humana Medicare Advantage |
$301.35
|
| Rate for Payer: Kentucky WC Medicaid |
$304.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$307.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
OS PATH PROCEDURE LEVEL 7
|
Facility
|
IP
|
$116.20
|
|
|
Service Code
|
HCPCS 81406
|
| Hospital Charge Code |
30002056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: Aetna Commercial |
$89.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.31
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: Cigna Commercial |
$96.45
|
| Rate for Payer: First Health Commercial |
$110.39
|
| Rate for Payer: Humana Commercial |
$98.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.26
|
| Rate for Payer: Ohio Health Group HMO |
$87.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.02
|
| Rate for Payer: PHCS Commercial |
$111.55
|
| Rate for Payer: United Healthcare All Payer |
$102.26
|
|
|
OS PATH PROCEDURE LEVEL 7
|
Facility
|
OP
|
$116.20
|
|
|
Service Code
|
HCPCS 81406
|
| Hospital Charge Code |
30002056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$396.03 |
| Rate for Payer: Aetna Commercial |
$89.47
|
| Rate for Payer: Anthem Medicaid |
$282.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$282.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$396.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$282.88
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: Cigna Commercial |
$96.45
|
| Rate for Payer: First Health Commercial |
$110.39
|
| Rate for Payer: Humana Commercial |
$98.77
|
| Rate for Payer: Humana KY Medicaid |
$282.88
|
| Rate for Payer: Humana Medicare Advantage |
$282.88
|
| Rate for Payer: Kentucky WC Medicaid |
$285.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$288.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.26
|
| Rate for Payer: Ohio Health Group HMO |
$87.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.02
|
| Rate for Payer: PHCS Commercial |
$111.55
|
| Rate for Payer: United Healthcare All Payer |
$102.26
|
|
|
OS PATH PROCEDURE LEVEL 8
|
Facility
|
IP
|
$347.64
|
|
|
Service Code
|
HCPCS 81407
|
| Hospital Charge Code |
30002057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$333.73 |
| Rate for Payer: Aetna Commercial |
$267.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.15
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cigna Commercial |
$288.54
|
| Rate for Payer: First Health Commercial |
$330.26
|
| Rate for Payer: Humana Commercial |
$295.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.92
|
| Rate for Payer: Ohio Health Group HMO |
$260.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.77
|
| Rate for Payer: PHCS Commercial |
$333.73
|
| Rate for Payer: United Healthcare All Payer |
$305.92
|
|
|
OS PATH PROCEDURE LEVEL 8
|
Facility
|
OP
|
$347.64
|
|
|
Service Code
|
HCPCS 81407
|
| Hospital Charge Code |
30002057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$1,184.78 |
| Rate for Payer: Aetna Commercial |
$267.68
|
| Rate for Payer: Anthem Medicaid |
$846.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$846.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,184.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$846.27
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cigna Commercial |
$288.54
|
| Rate for Payer: First Health Commercial |
$330.26
|
| Rate for Payer: Humana Commercial |
$295.49
|
| Rate for Payer: Humana KY Medicaid |
$846.27
|
| Rate for Payer: Humana Medicare Advantage |
$846.27
|
| Rate for Payer: Kentucky WC Medicaid |
$854.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,015.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$863.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.92
|
| Rate for Payer: Ohio Health Group HMO |
$260.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.77
|
| Rate for Payer: PHCS Commercial |
$333.73
|
| Rate for Payer: United Healthcare All Payer |
$305.92
|
|
|
OS PATH PROCEDURE LEVEL 9
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
HCPCS 81408
|
| Hospital Charge Code |
30001956
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$212.94 |
| Max. Negotiated Rate |
$1,572.48 |
| Rate for Payer: Aetna Commercial |
$1,261.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,315.31
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$1,359.54
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: Humana Commercial |
$1,392.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,343.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,208.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$491.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,441.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,228.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$507.78
|
| Rate for Payer: PHCS Commercial |
$1,572.48
|
| Rate for Payer: United Healthcare All Payer |
$1,441.44
|
|
|
OS PATH PROCEDURE LEVEL 9
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
HCPCS 81408
|
| Hospital Charge Code |
30001956
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$212.94 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,261.26
|
| Rate for Payer: Anthem Medicaid |
$2,000.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,000.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,315.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,800.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,000.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$1,359.54
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: Humana Commercial |
$1,392.30
|
| Rate for Payer: Humana KY Medicaid |
$2,000.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,000.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,343.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,208.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,441.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,228.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$507.78
|
| Rate for Payer: PHCS Commercial |
$1,572.48
|
| Rate for Payer: United Healthcare All Payer |
$1,441.44
|
|
|
OS PCA-1
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
OS PCA-1
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| 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 |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
OS PCA-2
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
OS PCA-2
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| 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 |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
OS PCA-TR
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| 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 |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
OS PCA-TR
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
OS PCP MH
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 83992
|
| Hospital Charge Code |
30000467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.17 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$20.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.71
|
| 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 |
$20.17
|
| Rate for Payer: Kentucky WC Medicaid |
$20.37
|
| 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: Molina Healthcare Medicaid |
$20.57
|
| 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 PCP MH
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 83992
|
| Hospital Charge Code |
30000467
|
|
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 PDGFRA GENE
|
Facility
|
OP
|
$1,148.69
|
|
|
Service Code
|
HCPCS 81314
|
| Hospital Charge Code |
30002002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.33 |
| Max. Negotiated Rate |
$1,102.74 |
| Rate for Payer: Aetna Commercial |
$884.49
|
| Rate for Payer: Anthem Medicaid |
$329.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$922.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$329.51
|
| Rate for Payer: Cash Price |
$574.34
|
| Rate for Payer: Cash Price |
$574.34
|
| Rate for Payer: Cigna Commercial |
$953.41
|
| Rate for Payer: First Health Commercial |
$1,091.26
|
| Rate for Payer: Humana Commercial |
$976.39
|
| Rate for Payer: Humana KY Medicaid |
$329.51
|
| Rate for Payer: Humana Medicare Advantage |
$329.51
|
| Rate for Payer: Kentucky WC Medicaid |
$332.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$941.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$847.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$336.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,010.85
|
| Rate for Payer: Ohio Health Group HMO |
$861.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.09
|
| Rate for Payer: PHCS Commercial |
$1,102.74
|
| Rate for Payer: United Healthcare All Payer |
$1,010.85
|
|
