|
OS TESTOSTERONE FREE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS 84402
|
| Hospital Charge Code |
30000521
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$198.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.17
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$214.14
|
| Rate for Payer: First Health Commercial |
$245.10
|
| Rate for Payer: Humana Commercial |
$219.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$211.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$190.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.04
|
| Rate for Payer: Ohio Health Group HMO |
$193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.98
|
| Rate for Payer: PHCS Commercial |
$247.68
|
| Rate for Payer: United Healthcare All Payer |
$227.04
|
|
|
OS TESTOSTERONE FREE
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
HCPCS 84402
|
| Hospital Charge Code |
30000521
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: Aetna Commercial |
$48.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$22.54
|
| Rate for Payer: Healthspan PPO |
$26.68
|
| Rate for Payer: Multiplan PHCS |
$154.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$180.60
|
| Rate for Payer: UHCCP Medicaid |
$90.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$15.28
|
|
|
OS TESTOSTERONE FREE
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS 84402
|
| Hospital Charge Code |
30000521
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$198.66
|
| Rate for Payer: Anthem Medicaid |
$25.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.47
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$214.14
|
| Rate for Payer: First Health Commercial |
$245.10
|
| Rate for Payer: Humana Commercial |
$219.30
|
| Rate for Payer: Humana KY Medicaid |
$25.47
|
| Rate for Payer: Humana Medicare Advantage |
$25.47
|
| Rate for Payer: Kentucky WC Medicaid |
$25.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$211.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$190.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.04
|
| Rate for Payer: Ohio Health Group HMO |
$193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.98
|
| Rate for Payer: PHCS Commercial |
$247.68
|
| Rate for Payer: United Healthcare All Payer |
$227.04
|
|
|
OS TESTOSTERONE TOTAL
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
30000523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
OS TESTOSTERONE TOTAL
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
30000523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$47.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$261.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$22.78
|
| Rate for Payer: Healthspan PPO |
$21.34
|
| Rate for Payer: Multiplan PHCS |
$156.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.70
|
| Rate for Payer: UHCCP Medicaid |
$91.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$15.49
|
|
|
OS TESTOSTERONE TOTAL
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
30000523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$25.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.81
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$25.81
|
| Rate for Payer: Humana Medicare Advantage |
$25.81
|
| Rate for Payer: Kentucky WC Medicaid |
$26.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
OS TETANUS TOX IGG AB S
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 86774
|
| Hospital Charge Code |
30001213
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.58 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.46
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS TETANUS TOX IGG AB S
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 86774
|
| Hospital Charge Code |
30001213
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem Medicaid |
$14.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.80
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Humana KY Medicaid |
$14.80
|
| Rate for Payer: Humana Medicare Advantage |
$14.80
|
| Rate for Payer: Kentucky WC Medicaid |
$14.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.46
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS THC CONFIRMATION
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| 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 |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS THC CONFIRMATION
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS THC MH
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| 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 |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.82
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
OS THC MH
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.82
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
OS THIAMIN VITAMIN B1 WB
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
30000524
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem Medicaid |
$21.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.23
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Humana KY Medicaid |
$21.23
|
| Rate for Payer: Humana Medicare Advantage |
$21.23
|
| Rate for Payer: Kentucky WC Medicaid |
$21.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.59
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
OS THIAMIN VITAMIN B1 WB
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
30000524
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.77
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.59
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
OS THROMBIN TIME
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 85670
|
| Hospital Charge Code |
30000628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.92
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.17
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
OS THROMBIN TIME
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 85670
|
| Hospital Charge Code |
30000628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem Medicaid |
$5.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.77
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Humana KY Medicaid |
$5.77
|
| Rate for Payer: Humana Medicare Advantage |
$5.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.17
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
OS THYME IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000833
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS THYME IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000833
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS THYROGLOBULIN
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
30001805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem Medicaid |
$15.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.91
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Humana KY Medicaid |
$15.91
|
| Rate for Payer: Humana Medicare Advantage |
$15.91
|
| Rate for Payer: Kentucky WC Medicaid |
$16.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
OS THYROGLOBULIN
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
30001805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
OS THYROGLOBULIN
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
30001805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna Commercial |
$10.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$137.00
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$14.16
|
| Rate for Payer: Healthspan PPO |
$16.66
|
| Rate for Payer: Multiplan PHCS |
$82.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.90
|
| Rate for Payer: UHCCP Medicaid |
$47.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.55
|
|
|
OS THYROGLOBULIN TUMOR MARK S
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 84432
|
| Hospital Charge Code |
30000525
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
OS THYROGLOBULIN TUMOR MARK S
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 84432
|
| Hospital Charge Code |
30000525
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$16.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.06
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$16.06
|
| Rate for Payer: Humana Medicare Advantage |
$16.06
|
| Rate for Payer: Kentucky WC Medicaid |
$16.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
OS THYROID STIMULATING IMM TSI
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS 84445
|
| Hospital Charge Code |
30000532
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.14 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna Commercial |
$445.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.13
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cigna Commercial |
$479.74
|
| Rate for Payer: First Health Commercial |
$549.10
|
| Rate for Payer: Humana Commercial |
$491.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$473.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$426.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$508.64
|
| Rate for Payer: Ohio Health Group HMO |
$433.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.18
|
| Rate for Payer: PHCS Commercial |
$554.88
|
| Rate for Payer: United Healthcare All Payer |
$508.64
|
|
|
OS THYROID STIMULATING IMM TSI
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS 84445
|
| Hospital Charge Code |
30000532
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna Commercial |
$445.06
|
| Rate for Payer: Anthem Medicaid |
$50.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$50.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$50.86
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cigna Commercial |
$479.74
|
| Rate for Payer: First Health Commercial |
$549.10
|
| Rate for Payer: Humana Commercial |
$491.30
|
| Rate for Payer: Humana KY Medicaid |
$50.86
|
| Rate for Payer: Humana Medicare Advantage |
$50.86
|
| Rate for Payer: Kentucky WC Medicaid |
$51.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$473.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$426.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$508.64
|
| Rate for Payer: Ohio Health Group HMO |
$433.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.18
|
| Rate for Payer: PHCS Commercial |
$554.88
|
| Rate for Payer: United Healthcare All Payer |
$508.64
|
|
