|
OS TRAMADOL CONFIRMATION
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000173
|
|
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 TRAMADOL MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS TRAMADOL MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| 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 |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS TRB GENE REARRANGE AMPLIFY
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 81340
|
| Hospital Charge Code |
30000197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem Medicaid |
$208.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$208.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$292.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$208.92
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Humana KY Medicaid |
$208.92
|
| Rate for Payer: Humana Medicare Advantage |
$208.92
|
| Rate for Payer: Kentucky WC Medicaid |
$211.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$213.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.08
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
OS TRB GENE REARRANGE AMPLIFY
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 81340
|
| Hospital Charge Code |
30000197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.70
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.08
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
OS TREE PANEL 1 IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000961
|
|
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 TREE PANEL 1 IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000961
|
|
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 TREE PANEL 2 IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000751
|
|
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 TREE PANEL 2 IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000751
|
|
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 TRG GENE REARRANGEMENT
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 81342
|
| Hospital Charge Code |
30000198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem Medicaid |
$201.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$201.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$282.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$201.50
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Humana KY Medicaid |
$201.50
|
| Rate for Payer: Humana Medicare Advantage |
$201.50
|
| Rate for Payer: Kentucky WC Medicaid |
$203.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.08
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
OS TRG GENE REARRANGEMENT
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 81342
|
| Hospital Charge Code |
30000198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.70
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.08
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
OS TRICHODERMAVIRIDE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000757
|
|
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 TRICHODERMAVIRIDE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000757
|
|
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 TRICHOSPORON PULLULANS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000879
|
|
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 TRICHOSPORON PULLULANS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000879
|
|
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 TRICYCLIC ANTIDEPRESSANT MH
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000097
|
|
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 TRICYCLIC ANTIDEPRESSANT MH
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000097
|
|
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 TRICYCLIC ANTIDEP SCREEN S
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| 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 |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.88
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS TRICYCLIC ANTIDEP SCREEN S
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.88
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS TRIGLYCERIDES
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000540
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem Medicaid |
$5.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.74
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Humana KY Medicaid |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.74
|
| Rate for Payer: Kentucky WC Medicaid |
$5.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.91
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
OS TRIGLYCERIDES
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000540
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.91
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
OS TRYPTASE S
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
OS TRYPTASE S
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
OS TSH SENSITIVE S
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
30000531
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: Aetna Commercial |
$142.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.56
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: First Health Commercial |
$175.75
|
| Rate for Payer: Humana Commercial |
$157.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.80
|
| Rate for Payer: Ohio Health Group HMO |
$138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.35
|
| Rate for Payer: PHCS Commercial |
$177.60
|
| Rate for Payer: United Healthcare All Payer |
$162.80
|
|
|
OS TSH SENSITIVE S
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
30000531
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: Aetna Commercial |
$142.45
|
| Rate for Payer: Anthem Medicaid |
$16.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: First Health Commercial |
$175.75
|
| Rate for Payer: Humana Commercial |
$157.25
|
| Rate for Payer: Humana KY Medicaid |
$16.80
|
| Rate for Payer: Humana Medicare Advantage |
$16.80
|
| Rate for Payer: Kentucky WC Medicaid |
$16.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.80
|
| Rate for Payer: Ohio Health Group HMO |
$138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.35
|
| Rate for Payer: PHCS Commercial |
$177.60
|
| Rate for Payer: United Healthcare All Payer |
$162.80
|
|
