|
OS THYROPEROXIDASE (TPO) AB
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.56
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
OS THYROPEROXIDASE (TPO) AB
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$14.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$14.55
|
| Rate for Payer: Humana Medicare Advantage |
$14.55
|
| Rate for Payer: Kentucky WC Medicaid |
$14.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
OS THYROTROPIN RECEPTOR AB S
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
30000392
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$227.52 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Anthem Medicaid |
$18.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$190.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.40
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$196.71
|
| Rate for Payer: First Health Commercial |
$225.15
|
| Rate for Payer: Humana Commercial |
$201.45
|
| Rate for Payer: Humana KY Medicaid |
$18.40
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Kentucky WC Medicaid |
$18.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$194.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$208.56
|
| Rate for Payer: Ohio Health Group HMO |
$177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.47
|
| Rate for Payer: PHCS Commercial |
$227.52
|
| Rate for Payer: United Healthcare All Payer |
$208.56
|
|
|
OS THYROTROPIN RECEPTOR AB S
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
30000392
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$227.52 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$190.31
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$196.71
|
| Rate for Payer: First Health Commercial |
$225.15
|
| Rate for Payer: Humana Commercial |
$201.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$194.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$208.56
|
| Rate for Payer: Ohio Health Group HMO |
$177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.47
|
| Rate for Payer: PHCS Commercial |
$227.52
|
| Rate for Payer: United Healthcare All Payer |
$208.56
|
|
|
OS THYROXINE BIND GLOBULIN S
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 84442
|
| Hospital Charge Code |
30000529
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem Medicaid |
$14.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.78
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Humana KY Medicaid |
$14.78
|
| Rate for Payer: Humana Medicare Advantage |
$14.78
|
| Rate for Payer: Kentucky WC Medicaid |
$14.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
OS THYROXINE BIND GLOBULIN S
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 84442
|
| Hospital Charge Code |
30000529
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
OS THYROXINE BINDING CAPACITY
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
30001590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$6.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$6.47
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OS THYROXINE BINDING CAPACITY
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
30001590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OSTIAL 10FR CANNULA BIO TRONIC
|
Facility
|
OP
|
$3,801.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.21 |
| Max. Negotiated Rate |
$3,649.54 |
| Rate for Payer: Aetna Commercial |
$2,927.23
|
| Rate for Payer: Anthem Medicaid |
$1,307.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,965.25
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Cigna Commercial |
$3,155.33
|
| Rate for Payer: First Health Commercial |
$3,611.52
|
| Rate for Payer: Humana Commercial |
$3,231.36
|
| Rate for Payer: Humana KY Medicaid |
$1,307.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,320.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,117.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,805.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,333.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,345.41
|
| Rate for Payer: Ohio Health Group HMO |
$2,851.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.50
|
| Rate for Payer: PHCS Commercial |
$3,649.54
|
| Rate for Payer: United Healthcare All Payer |
$3,345.41
|
|
|
OSTIAL 10FR CANNULA BIO TRONIC
|
Facility
|
IP
|
$3,801.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.21 |
| Max. Negotiated Rate |
$3,649.54 |
| Rate for Payer: Aetna Commercial |
$2,927.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,965.25
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Cigna Commercial |
$3,155.33
|
| Rate for Payer: First Health Commercial |
$3,611.52
|
| Rate for Payer: Humana Commercial |
$3,231.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,117.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,805.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,345.41
|
| Rate for Payer: Ohio Health Group HMO |
$2,851.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.50
|
| Rate for Payer: PHCS Commercial |
$3,649.54
|
| Rate for Payer: United Healthcare All Payer |
$3,345.41
|
|
|
OS TISS CULTUR CHROMSOM ANALY
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
30001462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$790.96
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$305.35
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
OS TISS CULTUR CHROMSOM ANALY
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
30001462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$140.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$140.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$790.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$197.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$140.73
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Humana KY Medicaid |
$140.73
|
| Rate for Payer: Humana Medicare Advantage |
$140.73
|
| Rate for Payer: Kentucky WC Medicaid |
$142.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$305.35
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
OS TISS TRANSGLUTAMIN AB IGG
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
30000385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Humana KY Medicaid |
$11.53
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Kentucky WC Medicaid |
$11.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.12
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
OS TISS TRANSGLUTAMIN AB IGG
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
30000385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.12
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
OS TISSUE CULTURE AMNIOTIC FL
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
HCPCS 88235
|
| Hospital Charge Code |
30001463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.51 |
| Max. Negotiated Rate |
$409.92 |
| Rate for Payer: Aetna Commercial |
$328.79
|
| Rate for Payer: Anthem Medicaid |
$150.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$150.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$210.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.30
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cigna Commercial |
$354.41
|
| Rate for Payer: First Health Commercial |
$405.65
|
| Rate for Payer: Humana Commercial |
$362.95
|
| Rate for Payer: Humana KY Medicaid |
$150.30
|
| Rate for Payer: Humana Medicare Advantage |
$150.30
|
| Rate for Payer: Kentucky WC Medicaid |
$151.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$375.76
|
| Rate for Payer: Ohio Health Group HMO |
$320.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.37
|
| Rate for Payer: PHCS Commercial |
$409.92
|
| Rate for Payer: United Healthcare All Payer |
$375.76
|
|
|
OS TISSUE CULTURE AMNIOTIC FL
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
HCPCS 88235
|
| Hospital Charge Code |
30001463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.51 |
| Max. Negotiated Rate |
$409.92 |
| Rate for Payer: Aetna Commercial |
$328.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.88
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cigna Commercial |
$354.41
|
| Rate for Payer: First Health Commercial |
$405.65
|
| Rate for Payer: Humana Commercial |
$362.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$375.76
|
| Rate for Payer: Ohio Health Group HMO |
$320.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.37
|
| Rate for Payer: PHCS Commercial |
$409.92
|
| Rate for Payer: United Healthcare All Payer |
$375.76
|
|
|
OS TISSUE CULTURE LYMPHOCYTE
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
30001941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$543.36 |
| Rate for Payer: Aetna Commercial |
$435.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$454.50
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cigna Commercial |
$469.78
|
| Rate for Payer: First Health Commercial |
$537.70
|
| Rate for Payer: Humana Commercial |
$481.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.08
|
| Rate for Payer: Ohio Health Group HMO |
$424.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.46
|
| Rate for Payer: PHCS Commercial |
$543.36
|
| Rate for Payer: United Healthcare All Payer |
$498.08
|
|
|
OS TISSUE CULTURE LYMPHOCYTE
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
30001941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$543.36 |
| Rate for Payer: Aetna Commercial |
$435.82
|
| Rate for Payer: Anthem Medicaid |
$116.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$116.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$454.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$163.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$116.49
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cigna Commercial |
$469.78
|
| Rate for Payer: First Health Commercial |
$537.70
|
| Rate for Payer: Humana Commercial |
$481.10
|
| Rate for Payer: Humana KY Medicaid |
$116.49
|
| Rate for Payer: Humana Medicare Advantage |
$116.49
|
| Rate for Payer: Kentucky WC Medicaid |
$117.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.08
|
| Rate for Payer: Ohio Health Group HMO |
$424.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.46
|
| Rate for Payer: PHCS Commercial |
$543.36
|
| Rate for Payer: United Healthcare All Payer |
$498.08
|
|
|
OS TISSUE CULTURE MAYO
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
30001465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$752.64 |
| Rate for Payer: Aetna Commercial |
$603.68
|
| Rate for Payer: Anthem Medicaid |
$143.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$143.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$201.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.75
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna Commercial |
$650.72
|
| Rate for Payer: First Health Commercial |
$744.80
|
| Rate for Payer: Humana Commercial |
$666.40
|
| Rate for Payer: Humana KY Medicaid |
$143.75
|
| Rate for Payer: Humana Medicare Advantage |
$143.75
|
| Rate for Payer: Kentucky WC Medicaid |
$145.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.92
|
| Rate for Payer: Ohio Health Group HMO |
$588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.04
|
| Rate for Payer: PHCS Commercial |
$752.64
|
| Rate for Payer: United Healthcare All Payer |
$689.92
|
|
|
OS TISSUE CULTURE MAYO
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
30001465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$752.64 |
| Rate for Payer: Aetna Commercial |
$603.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.55
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna Commercial |
$650.72
|
| Rate for Payer: First Health Commercial |
$744.80
|
| Rate for Payer: Humana Commercial |
$666.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.92
|
| Rate for Payer: Ohio Health Group HMO |
$588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.04
|
| Rate for Payer: PHCS Commercial |
$752.64
|
| Rate for Payer: United Healthcare All Payer |
$689.92
|
|
|
OS TISSUE EXAM BY PATHOLOGIST
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
30001953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$239.04 |
| Rate for Payer: Aetna Commercial |
$191.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.95
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: First Health Commercial |
$236.55
|
| Rate for Payer: Humana Commercial |
$211.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$204.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$219.12
|
| Rate for Payer: Ohio Health Group HMO |
$186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.19
|
| Rate for Payer: PHCS Commercial |
$239.04
|
| Rate for Payer: United Healthcare All Payer |
$219.12
|
|
|
OS TISSUE EXAM BY PATHOLOGIST
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
30001953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$239.04 |
| Rate for Payer: Aetna Commercial |
$191.73
|
| Rate for Payer: Anthem Medicaid |
$85.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: First Health Commercial |
$236.55
|
| Rate for Payer: Humana Commercial |
$211.65
|
| Rate for Payer: Humana KY Medicaid |
$85.63
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$86.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$204.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$219.12
|
| Rate for Payer: Ohio Health Group HMO |
$186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.19
|
| Rate for Payer: PHCS Commercial |
$239.04
|
| Rate for Payer: United Healthcare All Payer |
$219.12
|
|
|
OS TISSUE TRANSGLUT AB IGA S
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
30000379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.07
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.67
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
OS TISSUE TRANSGLUT AB IGA S
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
30000379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Humana KY Medicaid |
$11.53
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Kentucky WC Medicaid |
$11.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.67
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
OS TISSUE TRANS IGA
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
30000400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.43
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
