|
OS ELECTROPHORESIS 1
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
30000307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
OS ELECTROPHORESIS 1
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
30000307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem Medicaid |
$61.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$61.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$86.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Humana KY Medicaid |
$61.50
|
| Rate for Payer: Humana Medicare Advantage |
$61.50
|
| Rate for Payer: Kentucky WC Medicaid |
$62.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
OS ELECTROPHORESIS 2
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
30000310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem Medicaid |
$61.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$61.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$86.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Humana KY Medicaid |
$61.50
|
| Rate for Payer: Humana Medicare Advantage |
$61.50
|
| Rate for Payer: Kentucky WC Medicaid |
$62.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
OS ELECTROPHORESIS 2
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
30000310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
OS ELECTROPHORESIS 3
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
30000308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem Medicaid |
$61.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$61.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$86.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Humana KY Medicaid |
$61.50
|
| Rate for Payer: Humana Medicare Advantage |
$61.50
|
| Rate for Payer: Kentucky WC Medicaid |
$62.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
OS ELECTROPHORESIS 3
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
30000308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
OS ELECTROPHORETIC TECHNIQUE
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
30000306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem Medicaid |
$61.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$61.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$86.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.50
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Humana KY Medicaid |
$61.50
|
| Rate for Payer: Humana Medicare Advantage |
$61.50
|
| Rate for Payer: Kentucky WC Medicaid |
$62.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.86
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
OS ELECTROPHORETIC TECHNIQUE
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
30000306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.48
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.86
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
OS ELECTROPHORETIC TEST
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
30000309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem Medicaid |
$61.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$61.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$86.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Humana KY Medicaid |
$61.50
|
| Rate for Payer: Humana Medicare Advantage |
$61.50
|
| Rate for Payer: Kentucky WC Medicaid |
$62.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
OS ELECTROPHORETIC TEST
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
30000309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.63
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
OS ELK/MOOSE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000691
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS ELK/MOOSE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000691
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS ENDOMYSIAL AB IGA S
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 86231
|
| Hospital Charge Code |
30001032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$12.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.09
|
| Rate for Payer: Cash Price |
$87.00
|
| 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 |
$12.09
|
| Rate for Payer: Humana Medicare Advantage |
$12.09
|
| Rate for Payer: Kentucky WC Medicaid |
$12.21
|
| 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 |
$14.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.33
|
| 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 ENDOMYSIAL AB IGA S
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 86231
|
| Hospital Charge Code |
30001032
|
|
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 ENDOMYSIAL AB IGA TITER
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 86231
|
| Hospital Charge Code |
30001021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$226.56 |
| Rate for Payer: Aetna Commercial |
$181.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.51
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$195.88
|
| Rate for Payer: First Health Commercial |
$224.20
|
| Rate for Payer: Humana Commercial |
$200.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$193.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$207.68
|
| Rate for Payer: Ohio Health Group HMO |
$177.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.84
|
| Rate for Payer: PHCS Commercial |
$226.56
|
| Rate for Payer: United Healthcare All Payer |
$207.68
|
|
|
OS ENDOMYSIAL AB IGA TITER
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 86231
|
| Hospital Charge Code |
30001021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$226.56 |
| Rate for Payer: Aetna Commercial |
$181.72
|
| Rate for Payer: Anthem Medicaid |
$12.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.09
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$195.88
|
| Rate for Payer: First Health Commercial |
$224.20
|
| Rate for Payer: Humana Commercial |
$200.60
|
| Rate for Payer: Humana KY Medicaid |
$12.09
|
| Rate for Payer: Humana Medicare Advantage |
$12.09
|
| Rate for Payer: Kentucky WC Medicaid |
$12.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$193.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$207.68
|
| Rate for Payer: Ohio Health Group HMO |
$177.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.84
|
| Rate for Payer: PHCS Commercial |
$226.56
|
| Rate for Payer: United Healthcare All Payer |
$207.68
|
|
|
OS ENDOMYSIAL AB IGG SCREEN
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.30
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
OS ENDOMYSIAL AB IGG SCREEN
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.51
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.30
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
OS ENDOMYSIAL AB IGG TITER
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
30001031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
OS ENDOMYSIAL AB IGG TITER
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
30001031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
OS ENTAMOEB HIST AG
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 87337
|
| Hospital Charge Code |
30002074
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem Medicaid |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.98
|
| 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 |
$11.98
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Kentucky WC Medicaid |
$12.10
|
| 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 |
$14.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.22
|
| 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 ENTAMOEB HIST AG
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 87337
|
| Hospital Charge Code |
30002074
|
|
Hospital Revenue Code
|
306
|
| 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 ENTERVIRUS BY PCR
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
30001371
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.70 |
| Max. Negotiated Rate |
$411.84 |
| Rate for Payer: Aetna Commercial |
$330.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$344.49
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$356.07
|
| Rate for Payer: First Health Commercial |
$407.55
|
| Rate for Payer: Humana Commercial |
$364.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$351.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$316.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$377.52
|
| Rate for Payer: Ohio Health Group HMO |
$321.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.01
|
| Rate for Payer: PHCS Commercial |
$411.84
|
| Rate for Payer: United Healthcare All Payer |
$377.52
|
|
|
OS ENTERVIRUS BY PCR
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
30001371
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$411.84 |
| Rate for Payer: Aetna Commercial |
$330.33
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$344.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$356.07
|
| Rate for Payer: First Health Commercial |
$407.55
|
| Rate for Payer: Humana Commercial |
$364.65
|
| 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 |
$351.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$316.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$377.52
|
| Rate for Payer: Ohio Health Group HMO |
$321.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.01
|
| Rate for Payer: PHCS Commercial |
$411.84
|
| Rate for Payer: United Healthcare All Payer |
$377.52
|
|
|
OS EPICOCCUM PURPURASCENS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000758
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
