|
OS SEX HORMONE BINDING GLOB S
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 84270
|
| Hospital Charge Code |
30000510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
OS SEX HORMONE BINDING GLOB S
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 84270
|
| Hospital Charge Code |
30000510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem Medicaid |
$21.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.73
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Humana KY Medicaid |
$21.73
|
| Rate for Payer: Humana Medicare Advantage |
$21.73
|
| Rate for Payer: Kentucky WC Medicaid |
$21.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
OS SGPG IGM INDEX
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS SGPG IGM INDEX
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS SILVER BIRCH
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30001958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS SILVER BIRCH
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30001958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS SMPD1 GENE COMMON VARIANTS
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 81330
|
| Hospital Charge Code |
30001918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$47.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$47.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Humana KY Medicaid |
$47.00
|
| Rate for Payer: Humana Medicare Advantage |
$47.00
|
| Rate for Payer: Kentucky WC Medicaid |
$47.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.88
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS SMPD1 GENE COMMON VARIANTS
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 81330
|
| Hospital Charge Code |
30001918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.88
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS SODIUM FECES
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
30000513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
OS SODIUM FECES
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
30000513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem Medicaid |
$4.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.86
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Humana KY Medicaid |
$4.86
|
| Rate for Payer: Humana Medicare Advantage |
$4.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
OS SOLUBLE FIBRIN MONOMER
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 85366
|
| Hospital Charge Code |
30000600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.10 |
| Max. Negotiated Rate |
$355.20 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem Medicaid |
$80.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$80.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$112.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$80.46
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Humana KY Medicaid |
$80.46
|
| Rate for Payer: Humana Medicare Advantage |
$80.46
|
| Rate for Payer: Kentucky WC Medicaid |
$81.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.70
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
|
OS SOLUBLE FIBRIN MONOMER
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 85366
|
| Hospital Charge Code |
30000600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.10 |
| Max. Negotiated Rate |
$355.20 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.11
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.70
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
|
OS SOLUBL TRANSFERRIN RECEPTOR
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 84238
|
| Hospital Charge Code |
30001774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$59.52 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Anthem Medicaid |
$36.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$36.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$51.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.57
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$51.46
|
| Rate for Payer: First Health Commercial |
$58.90
|
| Rate for Payer: Humana Commercial |
$52.70
|
| Rate for Payer: Humana KY Medicaid |
$36.57
|
| Rate for Payer: Humana Medicare Advantage |
$36.57
|
| Rate for Payer: Kentucky WC Medicaid |
$36.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.56
|
| Rate for Payer: Ohio Health Group HMO |
$46.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.22
|
| Rate for Payer: PHCS Commercial |
$59.52
|
| Rate for Payer: United Healthcare All Payer |
$54.56
|
|
|
OS SOLUBL TRANSFERRIN RECEPTOR
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 84238
|
| Hospital Charge Code |
30001774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$59.52 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.79
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$51.46
|
| Rate for Payer: First Health Commercial |
$58.90
|
| Rate for Payer: Humana Commercial |
$52.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.56
|
| Rate for Payer: Ohio Health Group HMO |
$46.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.22
|
| Rate for Payer: PHCS Commercial |
$59.52
|
| Rate for Payer: United Healthcare All Payer |
$54.56
|
|
|
OS SOMA CYCLOBENZAPRINE MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS SOMA CYCLOBENZAPRINE MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS SPECIAL CONSULT
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 85390
|
| Hospital Charge Code |
30000605
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$15.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.48
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Humana KY Medicaid |
$15.48
|
| Rate for Payer: Humana Medicare Advantage |
$15.48
|
| Rate for Payer: Kentucky WC Medicaid |
$15.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.69
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
OS SPECIAL CONSULT
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 85390
|
| Hospital Charge Code |
30000605
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.69
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
OS SPECIAL STAIN
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30001514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$603.84 |
| Rate for Payer: Aetna Commercial |
$484.33
|
| Rate for Payer: Anthem Medicaid |
$216.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cigna Commercial |
$522.07
|
| Rate for Payer: First Health Commercial |
$597.55
|
| Rate for Payer: Humana Commercial |
$534.65
|
| Rate for Payer: Humana KY Medicaid |
$216.31
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$218.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$515.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$220.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$553.52
|
| Rate for Payer: Ohio Health Group HMO |
$471.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.99
|
| Rate for Payer: PHCS Commercial |
$603.84
|
| Rate for Payer: United Healthcare All Payer |
$553.52
|
|
|
OS SPECIAL STAIN
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30001514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.77 |
| Max. Negotiated Rate |
$603.84 |
| Rate for Payer: Aetna Commercial |
$484.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.09
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cigna Commercial |
$522.07
|
| Rate for Payer: First Health Commercial |
$597.55
|
| Rate for Payer: Humana Commercial |
$534.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$515.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$553.52
|
| Rate for Payer: Ohio Health Group HMO |
$471.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.99
|
| Rate for Payer: PHCS Commercial |
$603.84
|
| Rate for Payer: United Healthcare All Payer |
$553.52
|
|
|
OS SPECIAL STAINS GROUP 1
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
30001849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.45
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.96
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
|
OS SPECIAL STAINS GROUP 1
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
30001849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem Medicaid |
$74.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Humana KY Medicaid |
$74.28
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$75.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.96
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
|
OS SPERM ANTIBODY TEST
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 89325
|
| Hospital Charge Code |
30001844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem Medicaid |
$10.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.67
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Humana KY Medicaid |
$10.67
|
| Rate for Payer: Humana Medicare Advantage |
$10.67
|
| Rate for Payer: Kentucky WC Medicaid |
$10.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.45
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
OS SPERM ANTIBODY TEST
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 89325
|
| Hospital Charge Code |
30001844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.45
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
OS SPINE MUSC ATRO SMA CARRIER
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
HCPCS 81329
|
| Hospital Charge Code |
30000195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$299.52 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Anthem Medicaid |
$137.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$191.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$258.96
|
| Rate for Payer: First Health Commercial |
$296.40
|
| Rate for Payer: Humana Commercial |
$265.20
|
| Rate for Payer: Humana KY Medicaid |
$137.00
|
| Rate for Payer: Humana Medicare Advantage |
$137.00
|
| Rate for Payer: Kentucky WC Medicaid |
$138.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$255.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$274.56
|
| Rate for Payer: Ohio Health Group HMO |
$234.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.72
|
| Rate for Payer: PHCS Commercial |
$299.52
|
| Rate for Payer: United Healthcare All Payer |
$274.56
|
|
