|
OS DMD DUP/DELET ANALYSIS
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 81161
|
| Hospital Charge Code |
30001872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$466.20 |
| Max. Negotiated Rate |
$1,491.84 |
| Rate for Payer: Aetna Commercial |
$1,196.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,247.86
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,289.82
|
| Rate for Payer: First Health Commercial |
$1,476.30
|
| Rate for Payer: Humana Commercial |
$1,320.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,274.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,146.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,351.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.26
|
| Rate for Payer: PHCS Commercial |
$1,491.84
|
| Rate for Payer: United Healthcare All Payer |
$1,367.52
|
|
|
OS DMD DUP/DELET ANALYSIS
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 81161
|
| Hospital Charge Code |
30001872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$1,491.84 |
| Rate for Payer: Aetna Commercial |
$1,196.58
|
| Rate for Payer: Anthem Medicaid |
$279.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$279.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,247.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$390.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$279.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,289.82
|
| Rate for Payer: First Health Commercial |
$1,476.30
|
| Rate for Payer: Humana Commercial |
$1,320.90
|
| Rate for Payer: Humana KY Medicaid |
$279.00
|
| Rate for Payer: Humana Medicare Advantage |
$279.00
|
| Rate for Payer: Kentucky WC Medicaid |
$281.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,274.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,146.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,351.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.26
|
| Rate for Payer: PHCS Commercial |
$1,491.84
|
| Rate for Payer: United Healthcare All Payer |
$1,367.52
|
|
|
OS DNA PCR QUANT P
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
30001407
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.90 |
| Max. Negotiated Rate |
$434.88 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.76
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.57
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
OS DNA PCR QUANT P
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
30001407
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$434.88 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem Medicaid |
$42.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.84
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Humana KY Medicaid |
$42.84
|
| Rate for Payer: Humana Medicare Advantage |
$42.84
|
| Rate for Payer: Kentucky WC Medicaid |
$43.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.57
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
OS DNA PLOIDY
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
HCPCS 88182
|
| Hospital Charge Code |
30001427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$416.64 |
| Rate for Payer: Aetna Commercial |
$334.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$360.22
|
| Rate for Payer: First Health Commercial |
$412.30
|
| Rate for Payer: Humana Commercial |
$368.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$355.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$320.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$381.92
|
| Rate for Payer: Ohio Health Group HMO |
$325.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$377.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.46
|
| Rate for Payer: PHCS Commercial |
$416.64
|
| Rate for Payer: United Healthcare All Payer |
$381.92
|
|
|
OS DNA PLOIDY
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
HCPCS 88182
|
| Hospital Charge Code |
30001427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$416.64 |
| Rate for Payer: Aetna Commercial |
$334.18
|
| Rate for Payer: Anthem Medicaid |
$49.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$69.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.37
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$360.22
|
| Rate for Payer: First Health Commercial |
$412.30
|
| Rate for Payer: Humana Commercial |
$368.90
|
| 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 |
$355.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$320.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$381.92
|
| Rate for Payer: Ohio Health Group HMO |
$325.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$377.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.46
|
| Rate for Payer: PHCS Commercial |
$416.64
|
| Rate for Payer: United Healthcare All Payer |
$381.92
|
|
|
OS DNA PROBE 1
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001478
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE 1
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001478
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE 2
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE 2
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBEEACH 1
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBEEACH 1
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 10
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 10
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 11
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 11
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 12
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 12
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 2
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 2
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 3
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001479
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 3
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001479
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 4
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$21.42
|
| Rate for Payer: Humana Medicare Advantage |
$21.42
|
| Rate for Payer: Kentucky WC Medicaid |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 4
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
OS DNA PROBE EACH 5
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001471
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.59
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
