|
OS HISTOPLASMA AB 2
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001175
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem Medicaid |
$13.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.79
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Humana KY Medicaid |
$13.79
|
| Rate for Payer: Humana Medicare Advantage |
$13.79
|
| Rate for Payer: Kentucky WC Medicaid |
$13.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
OS HISTOPLASMA AB 2
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001175
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
OS HISTOPLASMA AB 3
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
OS HISTOPLASMA AB 3
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem Medicaid |
$13.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.79
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Humana KY Medicaid |
$13.79
|
| Rate for Payer: Humana Medicare Advantage |
$13.79
|
| Rate for Payer: Kentucky WC Medicaid |
$13.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
OS HISTOPLASMA AB SCREEN S
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$13.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.79
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Humana KY Medicaid |
$13.79
|
| Rate for Payer: Humana Medicare Advantage |
$13.79
|
| Rate for Payer: Kentucky WC Medicaid |
$13.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
OS HISTOPLASMA AB SCREEN S
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
30001176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
OS HISTOPLASMA ANTIGEN
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS HISTOPLASMA ANTIGEN
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS HISTOPLASMA ANTIGEN BR WASH
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS HISTOPLASMA ANTIGEN BR WASH
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS HISTOPLASMA ANTIGEN PCR
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$310.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.61
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cigna Commercial |
$334.49
|
| Rate for Payer: First Health Commercial |
$382.85
|
| Rate for Payer: Humana Commercial |
$342.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$330.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$297.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$354.64
|
| Rate for Payer: Ohio Health Group HMO |
$302.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$350.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.07
|
| Rate for Payer: PHCS Commercial |
$386.88
|
| Rate for Payer: United Healthcare All Payer |
$354.64
|
|
|
OS HISTOPLASMA ANTIGEN PCR
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$310.31
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cigna Commercial |
$334.49
|
| Rate for Payer: First Health Commercial |
$382.85
|
| Rate for Payer: Humana Commercial |
$342.55
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$330.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$297.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$354.64
|
| Rate for Payer: Ohio Health Group HMO |
$302.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$350.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.07
|
| Rate for Payer: PHCS Commercial |
$386.88
|
| Rate for Payer: United Healthcare All Payer |
$354.64
|
|
|
OS HISTOPLASMOSIS URINE
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS HISTOPLASMOSIS URINE
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
30001354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS HIV
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
30001181
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.74
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
OS HIV
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
30001181
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem Medicaid |
$13.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.71
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Humana KY Medicaid |
$13.71
|
| Rate for Payer: Humana Medicare Advantage |
$13.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.74
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
OS HIV1 AB DIFFERENTIATION S
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
30001179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$303.53
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.82
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
OS HIV1 AB DIFFERENTIATION S
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
30001179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem Medicaid |
$8.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$303.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.89
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Humana KY Medicaid |
$8.89
|
| Rate for Payer: Humana Medicare Advantage |
$8.89
|
| Rate for Payer: Kentucky WC Medicaid |
$8.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.82
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
OS HIV1 GENOTYPIC PRRT RESISTP
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS 87901
|
| Hospital Charge Code |
30001414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.45 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem Medicaid |
$257.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$257.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$360.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$257.45
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| 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 |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$308.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.38
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
OS HIV1 GENOTYPIC PRRT RESISTP
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS 87901
|
| Hospital Charge Code |
30001414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.41
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.38
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
OS HIV-1 RNA DETECT & QUANT P
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
30001381
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.06 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna Commercial |
$114.59
|
| Rate for Payer: Ambetter Exchange |
$85.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$85.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$102.12
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$75.28
|
| Rate for Payer: Healthspan PPO |
$125.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$85.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.10
|
| Rate for Payer: Multiplan PHCS |
$399.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$110.63
|
| Rate for Payer: UHCCP Medicaid |
$233.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.10
|
|
|
OS HIV-1 RNA DETECT & QUANT P
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
30001381
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$199.80 |
| Max. Negotiated Rate |
$639.36 |
| Rate for Payer: Aetna Commercial |
$512.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$534.80
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$552.78
|
| Rate for Payer: First Health Commercial |
$632.70
|
| Rate for Payer: Humana Commercial |
$566.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$491.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.08
|
| Rate for Payer: Ohio Health Group HMO |
$499.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$532.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$459.54
|
| Rate for Payer: PHCS Commercial |
$639.36
|
| Rate for Payer: United Healthcare All Payer |
$586.08
|
|
|
OS HIV-1 RNA DETECT & QUANT P
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
30001381
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$639.36 |
| Rate for Payer: Aetna Commercial |
$512.82
|
| Rate for Payer: Anthem Medicaid |
$85.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$85.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$534.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.10
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$552.78
|
| Rate for Payer: First Health Commercial |
$632.70
|
| Rate for Payer: Humana Commercial |
$566.10
|
| Rate for Payer: Humana KY Medicaid |
$85.10
|
| Rate for Payer: Humana Medicare Advantage |
$85.10
|
| Rate for Payer: Kentucky WC Medicaid |
$85.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$491.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$86.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.08
|
| Rate for Payer: Ohio Health Group HMO |
$499.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$532.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$459.54
|
| Rate for Payer: PHCS Commercial |
$639.36
|
| Rate for Payer: United Healthcare All Payer |
$586.08
|
|
|
OS HIV1 RNA QUALITATIVE
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS 87535
|
| Hospital Charge Code |
30001380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$289.92 |
| Rate for Payer: Aetna Commercial |
$232.54
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$242.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cigna Commercial |
$250.66
|
| Rate for Payer: First Health Commercial |
$286.90
|
| Rate for Payer: Humana Commercial |
$256.70
|
| 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 |
$247.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$265.76
|
| Rate for Payer: Ohio Health Group HMO |
$226.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.38
|
| Rate for Payer: PHCS Commercial |
$289.92
|
| Rate for Payer: United Healthcare All Payer |
$265.76
|
|
|
OS HIV1 RNA QUALITATIVE
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS 87535
|
| Hospital Charge Code |
30001380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.60 |
| Max. Negotiated Rate |
$289.92 |
| Rate for Payer: Aetna Commercial |
$232.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$242.51
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cigna Commercial |
$250.66
|
| Rate for Payer: First Health Commercial |
$286.90
|
| Rate for Payer: Humana Commercial |
$256.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$247.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$265.76
|
| Rate for Payer: Ohio Health Group HMO |
$226.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.38
|
| Rate for Payer: PHCS Commercial |
$289.92
|
| Rate for Payer: United Healthcare All Payer |
$265.76
|
|
