|
OS CHROMO ANALY HEMATO DISORD
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
30001469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.61 |
| Max. Negotiated Rate |
$749.76 |
| Rate for Payer: Aetna Commercial |
$601.37
|
| Rate for Payer: Anthem Medicaid |
$144.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$144.61
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cigna Commercial |
$648.23
|
| Rate for Payer: First Health Commercial |
$741.95
|
| Rate for Payer: Humana Commercial |
$663.85
|
| Rate for Payer: Humana KY Medicaid |
$144.61
|
| Rate for Payer: Humana Medicare Advantage |
$144.61
|
| Rate for Payer: Kentucky WC Medicaid |
$146.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$640.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$576.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$687.28
|
| Rate for Payer: Ohio Health Group HMO |
$585.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.89
|
| Rate for Payer: PHCS Commercial |
$749.76
|
| Rate for Payer: United Healthcare All Payer |
$687.28
|
|
|
OS CHROMO ANALY HEMATO DISORD
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
30001467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$668.16 |
| Rate for Payer: Aetna Commercial |
$535.92
|
| Rate for Payer: Anthem Medicaid |
$125.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$125.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$558.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$175.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.49
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$577.68
|
| Rate for Payer: First Health Commercial |
$661.20
|
| Rate for Payer: Humana Commercial |
$591.60
|
| Rate for Payer: Humana KY Medicaid |
$125.49
|
| Rate for Payer: Humana Medicare Advantage |
$125.49
|
| Rate for Payer: Kentucky WC Medicaid |
$126.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$570.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$513.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$612.48
|
| Rate for Payer: Ohio Health Group HMO |
$522.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.24
|
| Rate for Payer: PHCS Commercial |
$668.16
|
| Rate for Payer: United Healthcare All Payer |
$612.48
|
|
|
OS CHROMOGRANIN A S
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
30001042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$213.12 |
| Rate for Payer: Aetna Commercial |
$170.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.27
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$184.26
|
| Rate for Payer: First Health Commercial |
$210.90
|
| Rate for Payer: Humana Commercial |
$188.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$195.36
|
| Rate for Payer: Ohio Health Group HMO |
$166.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.18
|
| Rate for Payer: PHCS Commercial |
$213.12
|
| Rate for Payer: United Healthcare All Payer |
$195.36
|
|
|
OS CHROMOGRANIN A S
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
30001042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$213.12 |
| Rate for Payer: Aetna Commercial |
$170.94
|
| Rate for Payer: Anthem Medicaid |
$20.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$184.26
|
| Rate for Payer: First Health Commercial |
$210.90
|
| Rate for Payer: Humana Commercial |
$188.70
|
| Rate for Payer: Humana KY Medicaid |
$20.81
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Kentucky WC Medicaid |
$21.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$195.36
|
| Rate for Payer: Ohio Health Group HMO |
$166.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.18
|
| Rate for Payer: PHCS Commercial |
$213.12
|
| Rate for Payer: United Healthcare All Payer |
$195.36
|
|
|
OS Chromosomal Microarray, Blo
|
Facility
|
OP
|
$2,659.00
|
|
|
Service Code
|
HCPCS 81229
|
| Hospital Charge Code |
30001845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,160.00 |
| Max. Negotiated Rate |
$2,552.64 |
| Rate for Payer: Aetna Commercial |
$2,047.43
|
| Rate for Payer: Anthem Medicaid |
$1,160.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,160.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,135.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,624.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,329.50
|
| Rate for Payer: Cash Price |
$1,329.50
|
| Rate for Payer: Cigna Commercial |
$2,206.97
|
| Rate for Payer: First Health Commercial |
$2,526.05
|
| Rate for Payer: Humana Commercial |
$2,260.15
|
| Rate for Payer: Humana KY Medicaid |
$1,160.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,160.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,171.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,180.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,962.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,183.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,339.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,994.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,313.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,834.71
|
| Rate for Payer: PHCS Commercial |
$2,552.64
|
| Rate for Payer: United Healthcare All Payer |
$2,339.92
|
|
|
OS Chromosomal Microarray, Blo
|
Facility
|
IP
|
$2,659.00
|
|
|
Service Code
|
HCPCS 81229
|
| Hospital Charge Code |
30001845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$797.70 |
| Max. Negotiated Rate |
$2,552.64 |
| Rate for Payer: Aetna Commercial |
$2,047.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,135.18
|
| Rate for Payer: Cash Price |
$1,329.50
|
| Rate for Payer: Cigna Commercial |
$2,206.97
|
| Rate for Payer: First Health Commercial |
$2,526.05
|
| Rate for Payer: Humana Commercial |
$2,260.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,180.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,962.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$797.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,339.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,994.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,313.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,834.71
|
| Rate for Payer: PHCS Commercial |
$2,552.64
|
| Rate for Payer: United Healthcare All Payer |
$2,339.92
|
|
|
OS CHROMOSOME ADD KERYOTYPE
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
30001500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
OS CHROMOSOME ADD KERYOTYPE
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
30001500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.47 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$33.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$33.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$46.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.47
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Humana KY Medicaid |
$33.47
|
| Rate for Payer: Humana Medicare Advantage |
$33.47
|
| Rate for Payer: Kentucky WC Medicaid |
$33.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
OS CHROMOSOME ANALYSIS 5
|
Facility
|
IP
|
$357.75
|
|
|
Service Code
|
HCPCS 88261
|
| Hospital Charge Code |
30002013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$343.44 |
| Rate for Payer: Aetna Commercial |
$275.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.27
|
| Rate for Payer: Cash Price |
$178.88
|
| Rate for Payer: Cigna Commercial |
$296.93
|
| Rate for Payer: First Health Commercial |
$339.86
|
| Rate for Payer: Humana Commercial |
$304.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$293.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$314.82
|
| Rate for Payer: Ohio Health Group HMO |
$268.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$286.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.85
|
| Rate for Payer: PHCS Commercial |
$343.44
|
| Rate for Payer: United Healthcare All Payer |
$314.82
|
|
|
OS CHROMOSOME ANALYSIS 5
|
Facility
|
OP
|
$357.75
|
|
|
Service Code
|
HCPCS 88261
|
| Hospital Charge Code |
30002013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$246.85 |
| Max. Negotiated Rate |
$370.08 |
| Rate for Payer: Aetna Commercial |
$275.47
|
| Rate for Payer: Anthem Medicaid |
$264.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$264.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$370.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.34
|
| Rate for Payer: Cash Price |
$178.88
|
| Rate for Payer: Cash Price |
$178.88
|
| Rate for Payer: Cigna Commercial |
$296.93
|
| Rate for Payer: First Health Commercial |
$339.86
|
| Rate for Payer: Humana Commercial |
$304.09
|
| Rate for Payer: Humana KY Medicaid |
$264.34
|
| Rate for Payer: Humana Medicare Advantage |
$264.34
|
| Rate for Payer: Kentucky WC Medicaid |
$266.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$293.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$314.82
|
| Rate for Payer: Ohio Health Group HMO |
$268.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$286.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.85
|
| Rate for Payer: PHCS Commercial |
$343.44
|
| Rate for Payer: United Healthcare All Payer |
$314.82
|
|
|
OS CHROMOSOME COUNT ADDITIONAL
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 88285
|
| Hospital Charge Code |
30002014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.13
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
OS CHROMOSOME COUNT ADDITIONAL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 88285
|
| Hospital Charge Code |
30002014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$26.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.91
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$26.91
|
| Rate for Payer: Humana Medicare Advantage |
$26.91
|
| Rate for Payer: Kentucky WC Medicaid |
$27.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
OS CHROMSM INSITU HYBRDZATIO
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 88273
|
| Hospital Charge Code |
30001488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$271.68 |
| Rate for Payer: Aetna Commercial |
$217.91
|
| Rate for Payer: Anthem Medicaid |
$34.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.81
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$234.89
|
| Rate for Payer: First Health Commercial |
$268.85
|
| Rate for Payer: Humana Commercial |
$240.55
|
| Rate for Payer: Humana KY Medicaid |
$34.81
|
| Rate for Payer: Humana Medicare Advantage |
$34.81
|
| Rate for Payer: Kentucky WC Medicaid |
$35.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.04
|
| Rate for Payer: Ohio Health Group HMO |
$212.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.27
|
| Rate for Payer: PHCS Commercial |
$271.68
|
| Rate for Payer: United Healthcare All Payer |
$249.04
|
|
|
OS CHROMSM INSITU HYBRDZATIO
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 88273
|
| Hospital Charge Code |
30001488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.90 |
| Max. Negotiated Rate |
$271.68 |
| Rate for Payer: Aetna Commercial |
$217.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.25
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$234.89
|
| Rate for Payer: First Health Commercial |
$268.85
|
| Rate for Payer: Humana Commercial |
$240.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.04
|
| Rate for Payer: Ohio Health Group HMO |
$212.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.27
|
| Rate for Payer: PHCS Commercial |
$271.68
|
| Rate for Payer: United Healthcare All Payer |
$249.04
|
|
|
OS CHROMSOM ANAL AMNOTIC FL
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
HCPCS 88269
|
| Hospital Charge Code |
30001470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.66 |
| Max. Negotiated Rate |
$668.16 |
| Rate for Payer: Aetna Commercial |
$535.92
|
| Rate for Payer: Anthem Medicaid |
$173.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$558.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$243.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$173.66
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$577.68
|
| Rate for Payer: First Health Commercial |
$661.20
|
| Rate for Payer: Humana Commercial |
$591.60
|
| Rate for Payer: Humana KY Medicaid |
$173.66
|
| Rate for Payer: Humana Medicare Advantage |
$173.66
|
| Rate for Payer: Kentucky WC Medicaid |
$175.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$570.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$513.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$612.48
|
| Rate for Payer: Ohio Health Group HMO |
$522.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.24
|
| Rate for Payer: PHCS Commercial |
$668.16
|
| Rate for Payer: United Healthcare All Payer |
$612.48
|
|
|
OS CHROMSOM ANAL AMNOTIC FL
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
HCPCS 88269
|
| Hospital Charge Code |
30001470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$668.16 |
| Rate for Payer: Aetna Commercial |
$535.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$558.89
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$577.68
|
| Rate for Payer: First Health Commercial |
$661.20
|
| Rate for Payer: Humana Commercial |
$591.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$570.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$513.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$612.48
|
| Rate for Payer: Ohio Health Group HMO |
$522.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.24
|
| Rate for Payer: PHCS Commercial |
$668.16
|
| Rate for Payer: United Healthcare All Payer |
$612.48
|
|
|
OS CINNAMON IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS CINNAMON IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS CITRATE EXCRETION URINE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
30000284
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.70 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$281.37
|
| Rate for Payer: First Health Commercial |
$322.05
|
| Rate for Payer: Humana Commercial |
$288.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.32
|
| Rate for Payer: Ohio Health Group HMO |
$254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.91
|
| Rate for Payer: PHCS Commercial |
$325.44
|
| Rate for Payer: United Healthcare All Payer |
$298.32
|
|
|
OS CITRATE EXCRETION URINE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
30000284
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Anthem Medicaid |
$27.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.80
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$281.37
|
| Rate for Payer: First Health Commercial |
$322.05
|
| Rate for Payer: Humana Commercial |
$288.15
|
| Rate for Payer: Humana KY Medicaid |
$27.80
|
| Rate for Payer: Humana Medicare Advantage |
$27.80
|
| Rate for Payer: Kentucky WC Medicaid |
$28.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.32
|
| Rate for Payer: Ohio Health Group HMO |
$254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.91
|
| Rate for Payer: PHCS Commercial |
$325.44
|
| Rate for Payer: United Healthcare All Payer |
$298.32
|
|
|
OS CK TOTAL
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
30000293
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.81
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS CK TOTAL
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
30000293
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem Medicaid |
$13.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Humana KY Medicaid |
$13.39
|
| Rate for Payer: Humana Medicare Advantage |
$13.39
|
| Rate for Payer: Kentucky WC Medicaid |
$13.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.81
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS CLADOSPORIUM HERBARIUM IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000725
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS CLADOSPORIUM HERBARIUM IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000725
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS CLONAZEPAM S
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$210.24 |
| Rate for Payer: Aetna Commercial |
$168.63
|
| Rate for Payer: Anthem Medicaid |
$75.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.86
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cigna Commercial |
$181.77
|
| Rate for Payer: First Health Commercial |
$208.05
|
| Rate for Payer: Humana Commercial |
$186.15
|
| Rate for Payer: Humana KY Medicaid |
$75.31
|
| Rate for Payer: Kentucky WC Medicaid |
$76.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$179.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$192.72
|
| Rate for Payer: Ohio Health Group HMO |
$164.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.11
|
| Rate for Payer: PHCS Commercial |
$210.24
|
| Rate for Payer: United Healthcare All Payer |
$192.72
|
|
