|
OS HCG TOTAL
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
30000561
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.23
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
OS HCG TOTAL
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
30000561
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem Medicaid |
$15.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.05
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Humana KY Medicaid |
$15.05
|
| Rate for Payer: Humana Medicare Advantage |
$15.05
|
| Rate for Payer: Kentucky WC Medicaid |
$15.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
OS HCV AMPLIFICATION
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 87521
|
| Hospital Charge Code |
30001376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$190.07
|
| Rate for Payer: First Health Commercial |
$217.55
|
| Rate for Payer: Humana Commercial |
$194.65
|
| 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 |
$187.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$201.52
|
| Rate for Payer: Ohio Health Group HMO |
$171.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.01
|
| Rate for Payer: PHCS Commercial |
$219.84
|
| Rate for Payer: United Healthcare All Payer |
$201.52
|
|
|
OS HCV AMPLIFICATION
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS 87521
|
| Hospital Charge Code |
30001376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.89
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$190.07
|
| Rate for Payer: First Health Commercial |
$217.55
|
| Rate for Payer: Humana Commercial |
$194.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$187.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$201.52
|
| Rate for Payer: Ohio Health Group HMO |
$171.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.01
|
| Rate for Payer: PHCS Commercial |
$219.84
|
| Rate for Payer: United Healthcare All Payer |
$201.52
|
|
|
OS HCV FIBROSURE
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 81596
|
| Hospital Charge Code |
30000218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.10 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$213.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.43
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$229.91
|
| Rate for Payer: First Health Commercial |
$263.15
|
| Rate for Payer: Humana Commercial |
$235.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$243.76
|
| Rate for Payer: Ohio Health Group HMO |
$207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.13
|
| Rate for Payer: PHCS Commercial |
$265.92
|
| Rate for Payer: United Healthcare All Payer |
$243.76
|
|
|
OS HCV FIBROSURE
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 81596
|
| Hospital Charge Code |
30000218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.19 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$213.29
|
| Rate for Payer: Anthem Medicaid |
$72.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$72.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$101.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.19
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$229.91
|
| Rate for Payer: First Health Commercial |
$263.15
|
| Rate for Payer: Humana Commercial |
$235.45
|
| Rate for Payer: Humana KY Medicaid |
$72.19
|
| Rate for Payer: Humana Medicare Advantage |
$72.19
|
| Rate for Payer: Kentucky WC Medicaid |
$72.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$243.76
|
| Rate for Payer: Ohio Health Group HMO |
$207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.13
|
| Rate for Payer: PHCS Commercial |
$265.92
|
| Rate for Payer: United Healthcare All Payer |
$243.76
|
|
|
OS HCV GENOTYPE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
30001415
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$225.63 |
| Max. Negotiated Rate |
$360.43 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem Medicaid |
$257.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$257.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$360.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$257.45
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Humana KY Medicaid |
$257.45
|
| Rate for Payer: Humana Medicare Advantage |
$257.45
|
| Rate for Payer: Kentucky WC Medicaid |
$260.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$308.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.63
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
OS HCV GENOTYPE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
30001415
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.58
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.63
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
OS HEAVY METAL QUANT EACH NES
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
30001932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.49
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.55
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
OS HEAVY METAL QUANT EACH NES
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
30001932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem Medicaid |
$21.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.96
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Humana KY Medicaid |
$21.96
|
| Rate for Payer: Humana Medicare Advantage |
$21.96
|
| Rate for Payer: Kentucky WC Medicaid |
$22.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.55
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
OS HEAVYMET SCREEN W/DEMO B
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
HCPCS 83015
|
| Hospital Charge Code |
30000358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$444.48 |
| Rate for Payer: Aetna Commercial |
$356.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$371.79
|
| Rate for Payer: Cash Price |
$231.50
|
| Rate for Payer: Cigna Commercial |
$384.29
|
| Rate for Payer: First Health Commercial |
$439.85
|
| Rate for Payer: Humana Commercial |
$393.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.44
|
| Rate for Payer: Ohio Health Group HMO |
$347.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.47
|
| Rate for Payer: PHCS Commercial |
$444.48
|
| Rate for Payer: United Healthcare All Payer |
$407.44
|
|
|
OS HEAVYMET SCREEN W/DEMO B
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
HCPCS 83015
|
| Hospital Charge Code |
30000358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$444.48 |
| Rate for Payer: Aetna Commercial |
$356.51
|
| Rate for Payer: Anthem Medicaid |
$20.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$371.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.94
|
| Rate for Payer: Cash Price |
$231.50
|
| Rate for Payer: Cash Price |
$231.50
|
| Rate for Payer: Cigna Commercial |
$384.29
|
| Rate for Payer: First Health Commercial |
$439.85
|
| Rate for Payer: Humana Commercial |
$393.55
|
| Rate for Payer: Humana KY Medicaid |
$20.94
|
| Rate for Payer: Humana Medicare Advantage |
$20.94
|
| Rate for Payer: Kentucky WC Medicaid |
$21.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.44
|
| Rate for Payer: Ohio Health Group HMO |
$347.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.47
|
| Rate for Payer: PHCS Commercial |
$444.48
|
| Rate for Payer: United Healthcare All Payer |
$407.44
|
|
|
OS HEMOCHR HFE GENE ANALY B
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 81256
|
| Hospital Charge Code |
30000190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.36 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$65.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$91.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.36
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$65.36
|
| Rate for Payer: Humana Medicare Advantage |
$65.36
|
| Rate for Payer: Kentucky WC Medicaid |
$66.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
OS HEMOCHR HFE GENE ANALY B
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 81256
|
| Hospital Charge Code |
30000190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.26
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
OS HEMOGLB-OXGN AFFINITY
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
HCPCS 82820
|
| Hospital Charge Code |
30000336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$572.16 |
| Rate for Payer: Aetna Commercial |
$458.92
|
| Rate for Payer: Anthem Medicaid |
$13.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$478.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.34
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cigna Commercial |
$494.68
|
| Rate for Payer: First Health Commercial |
$566.20
|
| Rate for Payer: Humana Commercial |
$506.60
|
| Rate for Payer: Humana KY Medicaid |
$13.34
|
| Rate for Payer: Humana Medicare Advantage |
$13.34
|
| Rate for Payer: Kentucky WC Medicaid |
$13.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$488.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$524.48
|
| Rate for Payer: Ohio Health Group HMO |
$447.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$476.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$411.24
|
| Rate for Payer: PHCS Commercial |
$572.16
|
| Rate for Payer: United Healthcare All Payer |
$524.48
|
|
|
OS HEMOGLB-OXGN AFFINITY
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
HCPCS 82820
|
| Hospital Charge Code |
30000336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$572.16 |
| Rate for Payer: Aetna Commercial |
$458.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$478.59
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cigna Commercial |
$494.68
|
| Rate for Payer: First Health Commercial |
$566.20
|
| Rate for Payer: Humana Commercial |
$506.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$488.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$524.48
|
| Rate for Payer: Ohio Health Group HMO |
$447.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$476.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$411.24
|
| Rate for Payer: PHCS Commercial |
$572.16
|
| Rate for Payer: United Healthcare All Payer |
$524.48
|
|
|
OS HEMOGLOB F RBC DISTRIBUTON
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
30001429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.34
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
OS HEMOGLOB F RBC DISTRIBUTON
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
30001429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.35 |
| Max. Negotiated Rate |
$465.32 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$332.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$332.37
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$332.37
|
| Rate for Payer: Humana Medicare Advantage |
$332.37
|
| Rate for Payer: Kentucky WC Medicaid |
$335.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
OS HEMOGLOBIN A2 AND F
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
30000361
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.54
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS HEMOGLOBIN A2 AND F
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
30000361
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem Medicaid |
$18.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.06
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Humana KY Medicaid |
$18.06
|
| Rate for Payer: Humana Medicare Advantage |
$18.06
|
| Rate for Payer: Kentucky WC Medicaid |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.54
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS HEMOGLOBIN ELECTROPHORES
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
30000360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$12.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.87
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Humana KY Medicaid |
$12.87
|
| Rate for Payer: Humana Medicare Advantage |
$12.87
|
| Rate for Payer: Kentucky WC Medicaid |
$13.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OS HEMOGLOBIN ELECTROPHORES
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
30000360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OS Hemoglobin SF
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
30000515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$131.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.19
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
OS Hemoglobin SF
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
30000515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem Medicaid |
$8.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.10
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Humana KY Medicaid |
$8.10
|
| Rate for Payer: Humana Medicare Advantage |
$8.10
|
| Rate for Payer: Kentucky WC Medicaid |
$8.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$131.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.19
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
OS HEMOGLOBIN S SCRN B
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
30000626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem Medicaid |
$5.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.51
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Humana KY Medicaid |
$5.51
|
| Rate for Payer: Humana Medicare Advantage |
$5.51
|
| Rate for Payer: Kentucky WC Medicaid |
$5.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.27
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
