|
OS TUMOR IMMUNOHISTOCHEM/MANUA
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
30001994
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$391.68 |
| Rate for Payer: Aetna Commercial |
$314.16
|
| Rate for Payer: Anthem Medicaid |
$140.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$338.64
|
| Rate for Payer: First Health Commercial |
$387.60
|
| Rate for Payer: Humana Commercial |
$346.80
|
| Rate for Payer: Humana KY Medicaid |
$140.31
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$141.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$334.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.04
|
| Rate for Payer: Ohio Health Group HMO |
$306.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.48
|
| Rate for Payer: PHCS Commercial |
$391.68
|
| Rate for Payer: United Healthcare All Payer |
$359.04
|
|
|
OS TUMOR IMMUNOHISTOCHEM/MANUA
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
30001994
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$391.68 |
| Rate for Payer: Aetna Commercial |
$314.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.62
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$338.64
|
| Rate for Payer: First Health Commercial |
$387.60
|
| Rate for Payer: Humana Commercial |
$346.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$334.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.04
|
| Rate for Payer: Ohio Health Group HMO |
$306.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.48
|
| Rate for Payer: PHCS Commercial |
$391.68
|
| Rate for Payer: United Healthcare All Payer |
$359.04
|
|
|
OS TUMOR MICROSATELLITE INSTAB
|
Facility
|
OP
|
$1,278.00
|
|
|
Service Code
|
HCPCS 81301
|
| Hospital Charge Code |
30001992
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.14 |
| Max. Negotiated Rate |
$1,226.88 |
| Rate for Payer: Aetna Commercial |
$984.06
|
| Rate for Payer: Anthem Medicaid |
$348.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$348.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,026.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$487.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$348.56
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna Commercial |
$1,060.74
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: Humana Commercial |
$1,086.30
|
| Rate for Payer: Humana KY Medicaid |
$348.56
|
| Rate for Payer: Humana Medicare Advantage |
$348.56
|
| Rate for Payer: Kentucky WC Medicaid |
$352.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$418.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$355.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,124.64
|
| Rate for Payer: Ohio Health Group HMO |
$958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.18
|
| Rate for Payer: PHCS Commercial |
$1,226.88
|
| Rate for Payer: United Healthcare All Payer |
$1,124.64
|
|
|
OS TUMOR MICROSATELLITE INSTAB
|
Facility
|
IP
|
$1,278.00
|
|
|
Service Code
|
HCPCS 81301
|
| Hospital Charge Code |
30001992
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.14 |
| Max. Negotiated Rate |
$1,226.88 |
| Rate for Payer: Aetna Commercial |
$984.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,026.23
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna Commercial |
$1,060.74
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: Humana Commercial |
$1,086.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,124.64
|
| Rate for Payer: Ohio Health Group HMO |
$958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.18
|
| Rate for Payer: PHCS Commercial |
$1,226.88
|
| Rate for Payer: United Healthcare All Payer |
$1,124.64
|
|
|
OS TUNA IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000789
|
|
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 TUNA IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000789
|
|
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 TURKEY FEATHERS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000881
|
|
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 TURKEY FEATHERS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000881
|
|
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 TURKEY IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000755
|
|
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 TURKEY IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000755
|
|
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 TYPHUS FEVER GROUP AB IGG
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
30001206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$19.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.35
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$19.35
|
| Rate for Payer: Humana Medicare Advantage |
$19.35
|
| Rate for Payer: Kentucky WC Medicaid |
$19.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
OS TYPHUS FEVER GROUP AB IGG
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
30001206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
OS TYPHUS FEVER GROUP IGM
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
30001205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$19.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.35
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$19.35
|
| Rate for Payer: Humana Medicare Advantage |
$19.35
|
| Rate for Payer: Kentucky WC Medicaid |
$19.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
OS TYPHUS FEVER GROUP IGM
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
30001205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
OS TYROSINE
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 84510
|
| Hospital Charge Code |
30000546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.03
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.02
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
OS TYROSINE
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 84510
|
| Hospital Charge Code |
30000546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem Medicaid |
$10.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.63
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Humana KY Medicaid |
$10.63
|
| Rate for Payer: Humana Medicare Advantage |
$10.63
|
| Rate for Payer: Kentucky WC Medicaid |
$10.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.02
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
OS UGT2B15
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30001985
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$63.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$63.97
|
| Rate for Payer: Kentucky WC Medicaid |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS UGT2B15
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30001985
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS ULOCLADIUM CHARTARUM IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000720
|
|
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 ULOCLADIUM CHARTARUM IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000720
|
|
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 UNSTABLE HEMOGLOBIN
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 83068
|
| Hospital Charge Code |
30000365
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$9.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.47
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$9.47
|
| Rate for Payer: Kentucky WC Medicaid |
$9.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS UNSTABLE HEMOGLOBIN
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 83068
|
| Hospital Charge Code |
30000365
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
OS URINE CALCIUM
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
30000261
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
OS URINE CALCIUM
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
30000261
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$6.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.03
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$6.03
|
| Rate for Payer: Humana Medicare Advantage |
$6.03
|
| Rate for Payer: Kentucky WC Medicaid |
$6.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
OS URINE CORTISOL 24HR
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
30000287
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$222.72 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Anthem Medicaid |
$16.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$186.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.71
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna Commercial |
$192.56
|
| Rate for Payer: First Health Commercial |
$220.40
|
| Rate for Payer: Humana Commercial |
$197.20
|
| Rate for Payer: Humana KY Medicaid |
$16.71
|
| Rate for Payer: Humana Medicare Advantage |
$16.71
|
| Rate for Payer: Kentucky WC Medicaid |
$16.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$190.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$204.16
|
| Rate for Payer: Ohio Health Group HMO |
$174.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.92
|
| Rate for Payer: PHCS Commercial |
$222.72
|
| Rate for Payer: United Healthcare All Payer |
$204.16
|
|
