|
OS PROTEIN ELECTROPHER URINE
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
30000497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$128.64 |
| Rate for Payer: Aetna Commercial |
$103.18
|
| Rate for Payer: Anthem Medicaid |
$17.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.83
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cigna Commercial |
$111.22
|
| Rate for Payer: First Health Commercial |
$127.30
|
| Rate for Payer: Humana Commercial |
$113.90
|
| Rate for Payer: Humana KY Medicaid |
$17.83
|
| Rate for Payer: Humana Medicare Advantage |
$17.83
|
| Rate for Payer: Kentucky WC Medicaid |
$18.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.92
|
| Rate for Payer: Ohio Health Group HMO |
$100.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.54
|
| Rate for Payer: PHCS Commercial |
$128.64
|
| Rate for Payer: United Healthcare All Payer |
$117.92
|
|
|
OS PROTEIN ELECTROPHORESIS SER
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
30000496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem Medicaid |
$10.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.74
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Humana KY Medicaid |
$10.74
|
| Rate for Payer: Humana Medicare Advantage |
$10.74
|
| Rate for Payer: Kentucky WC Medicaid |
$10.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.68
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
OS PROTEIN ELECTROPHORESIS SER
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
30000496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.78
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.68
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
OS PROTEIN S ACTIVITY
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
30000594
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.00
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
OS PROTEIN S ACTIVITY
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
30000594
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$15.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.32
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$15.32
|
| Rate for Payer: Humana Medicare Advantage |
$15.32
|
| Rate for Payer: Kentucky WC Medicaid |
$15.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
OS PROTEIN S ANTIGEN TOTAL
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
30000593
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.44
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.26
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
OS PROTEIN S ANTIGEN TOTAL
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
30000593
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem Medicaid |
$11.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.61
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Humana KY Medicaid |
$11.61
|
| Rate for Payer: Humana Medicare Advantage |
$11.61
|
| Rate for Payer: Kentucky WC Medicaid |
$11.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.26
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
OS PROTEIN, SERUM, TOTAL
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
30001829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$3.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.67
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Humana KY Medicaid |
$3.67
|
| Rate for Payer: Humana Medicare Advantage |
$3.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.46
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
OS PROTEIN, SERUM, TOTAL
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
30001829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.46
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
OS PROTEIN TOTAL
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
30000493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.97 |
| 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 |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS PROTEIN TOTAL
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
30000493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$3.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.67
|
| 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 |
$3.67
|
| Rate for Payer: Humana Medicare Advantage |
$3.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3.71
|
| 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 |
$4.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.74
|
| 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 |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS PROTHROMBIN MUTATION
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
30001815
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$65.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$91.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.69
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Humana KY Medicaid |
$65.69
|
| Rate for Payer: Humana Medicare Advantage |
$65.69
|
| Rate for Payer: Kentucky WC Medicaid |
$66.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.38
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
OS PROTHROMBIN MUTATION
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
30000186
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
OS PROTHROMBIN MUTATION
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
30001815
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.99
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.38
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
OS PROTHROMBIN MUTATION
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
30000186
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem Medicaid |
$65.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$91.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.69
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Humana KY Medicaid |
$65.69
|
| Rate for Payer: Humana Medicare Advantage |
$65.69
|
| Rate for Payer: Kentucky WC Medicaid |
$66.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
OS PROTHROMBIN TIME
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
30000619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$4.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.29
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$4.29
|
| Rate for Payer: Humana Medicare Advantage |
$4.29
|
| Rate for Payer: Kentucky WC Medicaid |
$4.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
OS PROTHROMBIN TIME
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
30000619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.42
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
OS PSA FREE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
30000491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.12
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
OS PSA FREE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
30000491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem Medicaid |
$18.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.39
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Humana KY Medicaid |
$18.39
|
| Rate for Payer: Humana Medicare Advantage |
$18.39
|
| Rate for Payer: Kentucky WC Medicaid |
$18.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.12
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
OS PSA TOTAL
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.58 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.46
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS PSA TOTAL
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem Medicaid |
$18.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.39
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Humana KY Medicaid |
$18.39
|
| Rate for Payer: Humana Medicare Advantage |
$18.39
|
| Rate for Payer: Kentucky WC Medicaid |
$18.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.46
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 82480
|
| Hospital Charge Code |
30000282
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.97 |
| 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 |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 82480
|
| Hospital Charge Code |
30000282
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$7.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.87
|
| 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 |
$7.87
|
| Rate for Payer: Humana Medicare Advantage |
$7.87
|
| Rate for Payer: Kentucky WC Medicaid |
$7.95
|
| 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 |
$9.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.03
|
| 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 |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS PSYCH GENE PANEL
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30002005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$60.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Humana KY Medicaid |
$60.53
|
| Rate for Payer: Kentucky WC Medicaid |
$61.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
OS PSYCH GENE PANEL
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30002005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
