|
OS DNA PROBE EACH 5
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001471
|
|
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 6
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001482
|
|
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 6
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001482
|
|
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 7
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001485
|
|
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 7
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001485
|
|
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 8
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001486
|
|
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 8
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001486
|
|
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 9
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001480
|
|
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 9
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
30001480
|
|
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/RNA AMPLIFIED PROBE
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 87150
|
| Hospital Charge Code |
30001934
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.24
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
OS DNA/RNA AMPLIFIED PROBE
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 87150
|
| Hospital Charge Code |
30001934
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| 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 |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
OS DNASE IGG
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 88350
|
| Hospital Charge Code |
30001531
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS DNASE IGG
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 88350
|
| Hospital Charge Code |
30001531
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$59.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$59.84
|
| Rate for Payer: Kentucky WC Medicaid |
$60.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS DOXEPIN
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
30000095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.71
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
OS DOXEPIN
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.71 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| 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 |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.71
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
OS DOXEPIN
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.71
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
OS DOXEPIN
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
30000095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem Medicaid |
$20.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Humana KY Medicaid |
$20.29
|
| Rate for Payer: Kentucky WC Medicaid |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.71
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
OS DPYD GENE COMMON VARIANTS
|
Facility
|
IP
|
$1,196.00
|
|
|
Service Code
|
HCPCS 81232
|
| Hospital Charge Code |
30002003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$358.80 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$920.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$960.39
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Cigna Commercial |
$992.68
|
| Rate for Payer: First Health Commercial |
$1,136.20
|
| Rate for Payer: Humana Commercial |
$1,016.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$980.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$882.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,052.48
|
| Rate for Payer: Ohio Health Group HMO |
$897.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.24
|
| Rate for Payer: PHCS Commercial |
$1,148.16
|
| Rate for Payer: United Healthcare All Payer |
$1,052.48
|
|
|
OS DPYD GENE COMMON VARIANTS
|
Facility
|
OP
|
$1,196.00
|
|
|
Service Code
|
HCPCS 81232
|
| Hospital Charge Code |
30002003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.81 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$920.92
|
| Rate for Payer: Anthem Medicaid |
$174.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$174.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$960.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$244.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$174.81
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Cigna Commercial |
$992.68
|
| Rate for Payer: First Health Commercial |
$1,136.20
|
| Rate for Payer: Humana Commercial |
$1,016.60
|
| 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 |
$980.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$882.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,052.48
|
| Rate for Payer: Ohio Health Group HMO |
$897.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.24
|
| Rate for Payer: PHCS Commercial |
$1,148.16
|
| Rate for Payer: United Healthcare All Payer |
$1,052.48
|
|
|
OS DRD2 ANTIPSYCHOTICS
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS DRD2 ANTIPSYCHOTICS
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem Medicaid |
$65.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Humana KY Medicaid |
$65.68
|
| Rate for Payer: Kentucky WC Medicaid |
$66.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS DRGSCREEN W/REFLEX WHOLEBLD
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$361.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$62.14
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Kentucky WC Medicaid |
$62.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
OS DRGSCREEN W/REFLEX WHOLEBLD
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$361.35
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
OS DRUG ASSAY FLECAINIDE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 80181
|
| Hospital Charge Code |
30001979
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$18.64
|
| Rate for Payer: Humana Medicare Advantage |
$18.64
|
| Rate for Payer: Kentucky WC Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
OS DRUG ASSAY FLECAINIDE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 80181
|
| Hospital Charge Code |
30001979
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
