|
OS CRYPTOCOCCUS ANTIBODY
|
Facility
|
OP
|
$94.50
|
|
|
Service Code
|
HCPCS 86641
|
| Hospital Charge Code |
30002059
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$72.77
|
| Rate for Payer: Anthem Medicaid |
$14.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.41
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna Commercial |
$78.44
|
| Rate for Payer: First Health Commercial |
$89.78
|
| Rate for Payer: Humana Commercial |
$80.33
|
| Rate for Payer: Humana KY Medicaid |
$14.41
|
| Rate for Payer: Humana Medicare Advantage |
$14.41
|
| Rate for Payer: Kentucky WC Medicaid |
$14.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.16
|
| Rate for Payer: Ohio Health Group HMO |
$70.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.20
|
| Rate for Payer: PHCS Commercial |
$90.72
|
| Rate for Payer: United Healthcare All Payer |
$83.16
|
|
|
OS CRYPTOCOCCUS ANTIBODY
|
Facility
|
IP
|
$94.50
|
|
|
Service Code
|
HCPCS 86641
|
| Hospital Charge Code |
30002059
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$72.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.88
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna Commercial |
$78.44
|
| Rate for Payer: First Health Commercial |
$89.78
|
| Rate for Payer: Humana Commercial |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.16
|
| Rate for Payer: Ohio Health Group HMO |
$70.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.20
|
| Rate for Payer: PHCS Commercial |
$90.72
|
| Rate for Payer: United Healthcare All Payer |
$83.16
|
|
|
OS CUCUMBER IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000784
|
|
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 CUCUMBER IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000784
|
|
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 CULTIVATED OAT IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000643
|
|
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 CULTIVATED OAT IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000643
|
|
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 CULTIVATED RYE GRASS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000825
|
|
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 CULTIVATED RYE GRASS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000825
|
|
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 CULTURE REFRRED FOR ID FUNG
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
30001280
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
OS CULTURE REFRRED FOR ID FUNG
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
30001280
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem Medicaid |
$10.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.32
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Humana KY Medicaid |
$10.32
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
OS CURRY IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000887
|
|
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 CURRY IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000887
|
|
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 CURVULARIA LUNATA IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000682
|
|
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 CURVULARIA LUNATA IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000682
|
|
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 CYCLIC CITRULINATED PEP AB
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
30001000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$180.48 |
| Rate for Payer: Aetna Commercial |
$144.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.96
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$156.04
|
| Rate for Payer: First Health Commercial |
$178.60
|
| Rate for Payer: Humana Commercial |
$159.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.44
|
| Rate for Payer: Ohio Health Group HMO |
$141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.72
|
| Rate for Payer: PHCS Commercial |
$180.48
|
| Rate for Payer: United Healthcare All Payer |
$165.44
|
|
|
OS CYCLIC CITRULINATED PEP AB
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
30001000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Aetna Commercial |
$30.27
|
| Rate for Payer: Ambetter Exchange |
$12.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.54
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$11.52
|
| Rate for Payer: Healthspan PPO |
$13.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.95
|
| Rate for Payer: Multiplan PHCS |
$112.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16.84
|
| Rate for Payer: UHCCP Medicaid |
$65.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.95
|
|
|
OS CYCLIC CITRULINATED PEP AB
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
30001000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$180.48 |
| Rate for Payer: Aetna Commercial |
$144.76
|
| Rate for Payer: Anthem Medicaid |
$12.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.95
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$156.04
|
| Rate for Payer: First Health Commercial |
$178.60
|
| Rate for Payer: Humana Commercial |
$159.80
|
| Rate for Payer: Humana KY Medicaid |
$12.95
|
| Rate for Payer: Humana Medicare Advantage |
$12.95
|
| Rate for Payer: Kentucky WC Medicaid |
$13.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.44
|
| Rate for Payer: Ohio Health Group HMO |
$141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.72
|
| Rate for Payer: PHCS Commercial |
$180.48
|
| Rate for Payer: United Healthcare All Payer |
$165.44
|
|
|
OS CYCLOSPORINE BLOOD
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
30000023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: Aetna Commercial |
$177.87
|
| Rate for Payer: Anthem Medicaid |
$18.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$185.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$191.73
|
| Rate for Payer: First Health Commercial |
$219.45
|
| Rate for Payer: Humana Commercial |
$196.35
|
| Rate for Payer: Humana KY Medicaid |
$18.05
|
| Rate for Payer: Humana Medicare Advantage |
$18.05
|
| Rate for Payer: Kentucky WC Medicaid |
$18.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$189.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$170.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$203.28
|
| Rate for Payer: Ohio Health Group HMO |
$173.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.39
|
| Rate for Payer: PHCS Commercial |
$221.76
|
| Rate for Payer: United Healthcare All Payer |
$203.28
|
|
|
OS CYCLOSPORINE BLOOD
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
30000023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: Aetna Commercial |
$177.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$185.49
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$191.73
|
| Rate for Payer: First Health Commercial |
$219.45
|
| Rate for Payer: Humana Commercial |
$196.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$189.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$170.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$203.28
|
| Rate for Payer: Ohio Health Group HMO |
$173.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.39
|
| Rate for Payer: PHCS Commercial |
$221.76
|
| Rate for Payer: United Healthcare All Payer |
$203.28
|
|
|
OS CYP2C19 ANTIDEPRESSANT
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS 81225
|
| Hospital Charge Code |
30000183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$257.28 |
| Rate for Payer: Aetna Commercial |
$206.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.20
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$222.44
|
| Rate for Payer: First Health Commercial |
$254.60
|
| Rate for Payer: Humana Commercial |
$227.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$219.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$235.84
|
| Rate for Payer: Ohio Health Group HMO |
$201.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.92
|
| Rate for Payer: PHCS Commercial |
$257.28
|
| Rate for Payer: United Healthcare All Payer |
$235.84
|
|
|
OS CYP2C19 ANTIDEPRESSANT
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS 81225
|
| Hospital Charge Code |
30000183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$184.92 |
| Max. Negotiated Rate |
$407.90 |
| Rate for Payer: Aetna Commercial |
$206.36
|
| Rate for Payer: Anthem Medicaid |
$291.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$291.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$407.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$291.36
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$222.44
|
| Rate for Payer: First Health Commercial |
$254.60
|
| Rate for Payer: Humana Commercial |
$227.80
|
| Rate for Payer: Humana KY Medicaid |
$291.36
|
| Rate for Payer: Humana Medicare Advantage |
$291.36
|
| Rate for Payer: Kentucky WC Medicaid |
$294.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$219.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$297.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$235.84
|
| Rate for Payer: Ohio Health Group HMO |
$201.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.92
|
| Rate for Payer: PHCS Commercial |
$257.28
|
| Rate for Payer: United Healthcare All Payer |
$235.84
|
|
|
OS CYP2C9 GENE COM VARIANTS
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 81227
|
| Hospital Charge Code |
30002006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.34 |
| Max. Negotiated Rate |
$244.73 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$174.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$174.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$244.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$174.81
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$174.81
|
| Rate for Payer: Humana Medicare Advantage |
$174.81
|
| Rate for Payer: Kentucky WC Medicaid |
$176.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS CYP2C9 GENE COM VARIANTS
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 81227
|
| Hospital Charge Code |
30002006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS CYP2D6 ANTIDEPRESSANT
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 81226
|
| Hospital Charge Code |
30000184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.44
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$360.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.66
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
OS CYP2D6 ANTIDEPRESSANT
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 81226
|
| Hospital Charge Code |
30000184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$285.66 |
| Max. Negotiated Rate |
$631.27 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem Medicaid |
$450.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$450.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$631.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$450.91
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Humana KY Medicaid |
$450.91
|
| Rate for Payer: Humana Medicare Advantage |
$450.91
|
| Rate for Payer: Kentucky WC Medicaid |
$455.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$459.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$360.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.66
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
