|
OS TISSUE TRANS IGA
|
Facility
|
OP
|
$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 Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$26.50
|
| 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: 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 |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| 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
|
|
|
OS TOMATO IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000680
|
|
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 TOMATO IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000680
|
|
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 TOPIRMATE SERUM
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 80201
|
| Hospital Charge Code |
30000051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
OS TOPIRMATE SERUM
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 80201
|
| Hospital Charge Code |
30000051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$11.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.92
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Humana KY Medicaid |
$11.92
|
| Rate for Payer: Humana Medicare Advantage |
$11.92
|
| Rate for Payer: Kentucky WC Medicaid |
$12.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
OS TOTAL ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
30000472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$5.18
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
OS TOTAL ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
30000472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
OS TOXASSURE 13
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
30001777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$263.04 |
| Rate for Payer: Aetna Commercial |
$210.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$220.02
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$227.42
|
| Rate for Payer: First Health Commercial |
$260.30
|
| Rate for Payer: Humana Commercial |
$232.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$224.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$241.12
|
| Rate for Payer: Ohio Health Group HMO |
$205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.94
|
| Rate for Payer: PHCS Commercial |
$263.04
|
| Rate for Payer: United Healthcare All Payer |
$241.12
|
|
|
OS TOXASSURE 13
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
30001777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$263.04 |
| Rate for Payer: Aetna Commercial |
$210.98
|
| Rate for Payer: Anthem Medicaid |
$156.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$156.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$220.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$219.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$156.59
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$227.42
|
| Rate for Payer: First Health Commercial |
$260.30
|
| Rate for Payer: Humana Commercial |
$232.90
|
| Rate for Payer: Humana KY Medicaid |
$156.59
|
| Rate for Payer: Humana Medicare Advantage |
$156.59
|
| Rate for Payer: Kentucky WC Medicaid |
$158.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$224.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$241.12
|
| Rate for Payer: Ohio Health Group HMO |
$205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.94
|
| Rate for Payer: PHCS Commercial |
$263.04
|
| Rate for Payer: United Healthcare All Payer |
$241.12
|
|
|
OS TOXOCARA CANIS ANTIBODY S
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
30001163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$239.29
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.38
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
OS TOXOCARA CANIS ANTIBODY S
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
30001163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem Medicaid |
$13.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$239.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.01
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Humana KY Medicaid |
$13.01
|
| Rate for Payer: Humana Medicare Advantage |
$13.01
|
| Rate for Payer: Kentucky WC Medicaid |
$13.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.38
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
OS TOXOPLASMA AB IGM S
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
30001215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem Medicaid |
$14.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.41
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Humana KY Medicaid |
$14.41
|
| Rate for Payer: Humana Medicare Advantage |
$14.41
|
| Rate for Payer: Kentucky WC Medicaid |
$14.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.55
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
OS TOXOPLASMA AB IGM S
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
30001215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.62
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.55
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
OS TOXOPLASM GONDII BY PCR CSF
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001394
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$310.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.61
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cigna Commercial |
$334.49
|
| Rate for Payer: First Health Commercial |
$382.85
|
| Rate for Payer: Humana Commercial |
$342.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$330.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$297.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$354.64
|
| Rate for Payer: Ohio Health Group HMO |
$302.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.93
|
| Rate for Payer: PHCS Commercial |
$386.88
|
| Rate for Payer: United Healthcare All Payer |
$354.64
|
|
|
OS TOXOPLASM GONDII BY PCR CSF
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001394
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$310.31
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cigna Commercial |
$334.49
|
| Rate for Payer: First Health Commercial |
$382.85
|
| Rate for Payer: Humana Commercial |
$342.55
|
| 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 |
$330.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$297.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$354.64
|
| Rate for Payer: Ohio Health Group HMO |
$302.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.93
|
| Rate for Payer: PHCS Commercial |
$386.88
|
| Rate for Payer: United Healthcare All Payer |
$354.64
|
|
|
OS TP53 GENE TRGT SEQUENCE ALY
|
Facility
|
OP
|
$918.00
|
|
|
Service Code
|
HCPCS 81352
|
| Hospital Charge Code |
30001908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$881.28 |
| Rate for Payer: Aetna Commercial |
$706.86
|
| Rate for Payer: Anthem Medicaid |
$329.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$329.51
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cigna Commercial |
$761.94
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Humana Commercial |
$780.30
|
| Rate for Payer: Humana KY Medicaid |
$329.51
|
| Rate for Payer: Humana Medicare Advantage |
$329.51
|
| Rate for Payer: Kentucky WC Medicaid |
$332.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$752.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$677.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$336.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$807.84
|
| Rate for Payer: Ohio Health Group HMO |
$688.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.58
|
| Rate for Payer: PHCS Commercial |
$881.28
|
| Rate for Payer: United Healthcare All Payer |
$807.84
|
|
|
OS TP53 GENE TRGT SEQUENCE ALY
|
Facility
|
IP
|
$918.00
|
|
|
Service Code
|
HCPCS 81352
|
| Hospital Charge Code |
30001908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$881.28 |
| Rate for Payer: Aetna Commercial |
$706.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.15
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cigna Commercial |
$761.94
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Humana Commercial |
$780.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$752.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$677.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$275.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$807.84
|
| Rate for Payer: Ohio Health Group HMO |
$688.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.58
|
| Rate for Payer: PHCS Commercial |
$881.28
|
| Rate for Payer: United Healthcare All Payer |
$807.84
|
|
|
OS TPO ANTIBODIES
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
OS TPO ANTIBODIES
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$14.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| 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 |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
OS TRAMADOL
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.30 |
| 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 |
$42.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.10
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
OS TRAMADOL
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$14.94
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: Humana Commercial |
$15.30
|
| 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 |
$14.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$15.84
|
| Rate for Payer: Ohio Health Group HMO |
$13.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.58
|
| Rate for Payer: PHCS Commercial |
$17.28
|
| Rate for Payer: United Healthcare All Payer |
$15.84
|
|
|
OS TRAMADOL
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 80373
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$18.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Multiplan PHCS |
$10.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
|
|
OS TRAMADOL
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem Medicaid |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.14
|
| 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 |
$62.14
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Kentucky WC Medicaid |
$62.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.38
|
| 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 |
$42.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.10
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
OS TRAMADOL
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.45
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$14.94
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: Humana Commercial |
$15.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15.84
|
| Rate for Payer: Ohio Health Group HMO |
$13.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.58
|
| Rate for Payer: PHCS Commercial |
$17.28
|
| Rate for Payer: United Healthcare All Payer |
$15.84
|
|
|
OS TRAMADOL CONFIRMATION
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| 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 |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
