|
OS CYP3A5 GENE COMMON VARIANTS
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 81231
|
| Hospital Charge Code |
30002008
|
|
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 CYP3A5 GENE COMMON VARIANTS
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 81231
|
| Hospital Charge Code |
30002008
|
|
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 CYSTIC FIB PROFILE 32 MUT
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
30000182
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$610.56 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.71
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$508.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$438.84
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
OS CYSTIC FIB PROFILE 32 MUT
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
30000182
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$438.84 |
| Max. Negotiated Rate |
$779.24 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem Medicaid |
$556.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$556.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$779.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$556.60
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Humana KY Medicaid |
$556.60
|
| Rate for Payer: Humana Medicare Advantage |
$556.60
|
| Rate for Payer: Kentucky WC Medicaid |
$562.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$567.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$508.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$438.84
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
OS CYSTIC FIB PROFILE 97 MUT
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
30001800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$644.16 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.81
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$556.93
|
| Rate for Payer: First Health Commercial |
$637.45
|
| Rate for Payer: Humana Commercial |
$570.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$550.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$495.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$590.48
|
| Rate for Payer: Ohio Health Group HMO |
$503.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.99
|
| Rate for Payer: PHCS Commercial |
$644.16
|
| Rate for Payer: United Healthcare All Payer |
$590.48
|
|
|
OS CYSTIC FIB PROFILE 97 MUT
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
30001800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$218.85 |
| Max. Negotiated Rate |
$723.58 |
| Rate for Payer: Ambetter Exchange |
$556.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$556.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$556.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$667.92
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Healthspan PPO |
$218.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$556.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.60
|
| Rate for Payer: Multiplan PHCS |
$402.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$723.58
|
| Rate for Payer: UHCCP Medicaid |
$234.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$556.60
|
|
|
OS CYSTIC FIB PROFILE 97 MUT
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
30001800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$462.99 |
| Max. Negotiated Rate |
$779.24 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Anthem Medicaid |
$556.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$556.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$779.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$556.60
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$556.93
|
| Rate for Payer: First Health Commercial |
$637.45
|
| Rate for Payer: Humana Commercial |
$570.35
|
| Rate for Payer: Humana KY Medicaid |
$556.60
|
| Rate for Payer: Humana Medicare Advantage |
$556.60
|
| Rate for Payer: Kentucky WC Medicaid |
$562.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$550.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$495.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$567.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$590.48
|
| Rate for Payer: Ohio Health Group HMO |
$503.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.99
|
| Rate for Payer: PHCS Commercial |
$644.16
|
| Rate for Payer: United Healthcare All Payer |
$590.48
|
|
|
OS CYTOGENETIC STUDY
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 88299
|
| Hospital Charge Code |
30001501
|
|
Hospital Revenue Code
|
319
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.09
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
OS CYTOGENETIC STUDY
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 88299
|
| Hospital Charge Code |
30001501
|
|
Hospital Revenue Code
|
319
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem Medicaid |
$49.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$69.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.37
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Humana KY Medicaid |
$49.37
|
| Rate for Payer: Humana Medicare Advantage |
$49.37
|
| Rate for Payer: Kentucky WC Medicaid |
$49.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.09
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
OS CYTOGENOMIC NEO MICROR ALYS
|
Facility
|
OP
|
$3,878.00
|
|
|
Service Code
|
HCPCS 81277
|
| Hospital Charge Code |
30001920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,160.00 |
| Max. Negotiated Rate |
$3,722.88 |
| Rate for Payer: Aetna Commercial |
$2,986.06
|
| 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 |
$3,114.03
|
| 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 |
$1,939.00
|
| Rate for Payer: Cash Price |
$1,939.00
|
| Rate for Payer: Cigna Commercial |
$3,218.74
|
| Rate for Payer: First Health Commercial |
$3,684.10
|
| Rate for Payer: Humana Commercial |
$3,296.30
|
| 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 |
$3,179.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,861.96
|
| 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 |
$3,412.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,908.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,373.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,675.82
|
| Rate for Payer: PHCS Commercial |
$3,722.88
|
| Rate for Payer: United Healthcare All Payer |
$3,412.64
|
|
|
OS CYTOGENOMIC NEO MICROR ALYS
|
Facility
|
IP
|
$3,878.00
|
|
|
Service Code
|
HCPCS 81277
|
| Hospital Charge Code |
30001920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,163.40 |
| Max. Negotiated Rate |
$3,722.88 |
| Rate for Payer: Aetna Commercial |
$2,986.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,114.03
|
| Rate for Payer: Cash Price |
$1,939.00
|
| Rate for Payer: Cigna Commercial |
$3,218.74
|
| Rate for Payer: First Health Commercial |
$3,684.10
|
| Rate for Payer: Humana Commercial |
$3,296.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,179.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,861.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,163.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,412.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,908.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,373.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,675.82
|
| Rate for Payer: PHCS Commercial |
$3,722.88
|
| Rate for Payer: United Healthcare All Payer |
$3,412.64
|
|
|
OS CYTOMEGALOVIRUS IGG
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
30001140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OS CYTOMEGALOVIRUS IGG
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
30001140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$14.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$14.39
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Kentucky WC Medicaid |
$14.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OS CYTOMEGALOVIRUS IGM
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
30001141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem Medicaid |
$16.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.85
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Humana KY Medicaid |
$16.85
|
| Rate for Payer: Humana Medicare Advantage |
$16.85
|
| Rate for Payer: Kentucky WC Medicaid |
$17.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.95
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
OS CYTOMEGALOVIRUS IGM
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
30001141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.47
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.95
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
OS CYTOMEG PCR
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
30001859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$292.80 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.45
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
OS CYTOMEG PCR
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
30001859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$292.80 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.91
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.45
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
OS D2 FUNGAL SEQUENCING
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 87153
|
| Hospital Charge Code |
30001857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.36 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$115.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$115.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$161.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.36
|
| 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 |
$115.36
|
| Rate for Payer: Humana Medicare Advantage |
$115.36
|
| Rate for Payer: Kentucky WC Medicaid |
$116.51
|
| 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 |
$138.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.67
|
| 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 |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
OS D2 FUNGAL SEQUENCING
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 87153
|
| Hospital Charge Code |
30001857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.40 |
| 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 |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
OS DANDELION IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000761
|
|
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 DANDELION IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000761
|
|
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 D DIMER QUANTITATIVE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
30000602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$10.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.18
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$10.18
|
| Rate for Payer: Humana Medicare Advantage |
$10.18
|
| Rate for Payer: Kentucky WC Medicaid |
$10.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
OS D DIMER QUANTITATIVE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
30000602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.53
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
OS DEHYDROEPIANDROSTERON SERUM
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 82626
|
| Hospital Charge Code |
30000303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$13.59
|
| Rate for Payer: Ambetter Exchange |
$25.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.32
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$22.30
|
| Rate for Payer: Healthspan PPO |
$26.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.27
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.85
|
| Rate for Payer: UHCCP Medicaid |
$100.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$15.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.27
|
|
|
OS DEHYDROEPIANDROSTERON SERUM
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 82626
|
| Hospital Charge Code |
30000303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$231.26
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.72
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
