|
OS HIV2 AB DIFFERENTIATION S
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
HCPCS 86702
|
| Hospital Charge Code |
30001180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.10 |
| Max. Negotiated Rate |
$390.72 |
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.82
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$337.81
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: Humana Commercial |
$345.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$333.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$300.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$358.16
|
| Rate for Payer: Ohio Health Group HMO |
$305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$325.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$280.83
|
| Rate for Payer: PHCS Commercial |
$390.72
|
| Rate for Payer: United Healthcare All Payer |
$358.16
|
|
|
OS HIV2 AB DIFFERENTIATION S
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
HCPCS 86702
|
| Hospital Charge Code |
30001180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$390.72 |
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: Anthem Medicaid |
$13.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.52
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$337.81
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: Humana Commercial |
$345.95
|
| Rate for Payer: Humana KY Medicaid |
$13.52
|
| Rate for Payer: Humana Medicare Advantage |
$13.52
|
| Rate for Payer: Kentucky WC Medicaid |
$13.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$333.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$300.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$358.16
|
| Rate for Payer: Ohio Health Group HMO |
$305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$325.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$280.83
|
| Rate for Payer: PHCS Commercial |
$390.72
|
| Rate for Payer: United Healthcare All Payer |
$358.16
|
|
|
OS HIV-2 PROBE&REVRSE TRNSCRIP
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 87538
|
| Hospital Charge Code |
30002082
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna Commercial |
$254.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.99
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$273.90
|
| Rate for Payer: First Health Commercial |
$313.50
|
| Rate for Payer: Humana Commercial |
$280.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$270.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$243.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$290.40
|
| Rate for Payer: Ohio Health Group HMO |
$247.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.70
|
| Rate for Payer: PHCS Commercial |
$316.80
|
| Rate for Payer: United Healthcare All Payer |
$290.40
|
|
|
OS HIV-2 PROBE&REVRSE TRNSCRIP
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 87538
|
| Hospital Charge Code |
30002082
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna Commercial |
$254.10
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$273.90
|
| Rate for Payer: First Health Commercial |
$313.50
|
| Rate for Payer: Humana Commercial |
$280.50
|
| 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 |
$270.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$243.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$290.40
|
| Rate for Payer: Ohio Health Group HMO |
$247.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.70
|
| Rate for Payer: PHCS Commercial |
$316.80
|
| Rate for Payer: United Healthcare All Payer |
$290.40
|
|
|
OS HLA B 15 02
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 81381
|
| Hospital Charge Code |
30000201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.34 |
| Max. Negotiated Rate |
$237.86 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$169.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$169.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$237.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$169.90
|
| Rate for Payer: Cash Price |
$93.00
|
| 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 |
$169.90
|
| Rate for Payer: Humana Medicare Advantage |
$169.90
|
| Rate for Payer: Kentucky WC Medicaid |
$171.60
|
| 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 |
$203.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.30
|
| 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 |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS HLA B 15 02
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 81381
|
| Hospital Charge Code |
30000201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.80 |
| 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 |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS HLA-B27 SINGLE ANTGEN
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 86812
|
| Hospital Charge Code |
30001224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$25.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$211.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.81
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Humana KY Medicaid |
$25.81
|
| Rate for Payer: Humana Medicare Advantage |
$25.81
|
| Rate for Payer: Kentucky WC Medicaid |
$26.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.47
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
OS HLA-B27 SINGLE ANTGEN
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 86812
|
| Hospital Charge Code |
30001224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$211.19
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.47
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
OS HLA CLASS 1 MOL PHENOTYPE B
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 81372
|
| Hospital Charge Code |
30000199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$356.04 |
| Max. Negotiated Rate |
$565.03 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem Medicaid |
$403.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$403.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$565.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$403.59
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Humana KY Medicaid |
$403.59
|
| Rate for Payer: Humana Medicare Advantage |
$403.59
|
| Rate for Payer: Kentucky WC Medicaid |
$407.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
OS HLA CLASS 1 MOL PHENOTYPE B
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 81372
|
| Hospital Charge Code |
30000199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.35
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
OS HLA CLASS II TYP BY PCR
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 81375
|
| Hospital Charge Code |
30000200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$220.74 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem Medicaid |
$220.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$220.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$309.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$220.74
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Humana KY Medicaid |
$220.74
|
| Rate for Payer: Humana Medicare Advantage |
$220.74
|
| Rate for Payer: Kentucky WC Medicaid |
$222.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$225.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
OS HLA CLASS II TYP BY PCR
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 81375
|
| Hospital Charge Code |
30000200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.35
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
OS HLA DQA1
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS 81382
|
| Hospital Charge Code |
30000202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.44
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS HLA DQA1
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS 81382
|
| Hospital Charge Code |
30000202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.68 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem Medicaid |
$123.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$123.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$173.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.68
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Humana KY Medicaid |
$123.68
|
| Rate for Payer: Humana Medicare Advantage |
$123.68
|
| Rate for Payer: Kentucky WC Medicaid |
$124.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.44
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS HLA DQA2
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS 81382
|
| Hospital Charge Code |
30000203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.68 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem Medicaid |
$123.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$123.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$173.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.68
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Humana KY Medicaid |
$123.68
|
| Rate for Payer: Humana Medicare Advantage |
$123.68
|
| Rate for Payer: Kentucky WC Medicaid |
$124.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.44
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS HLA DQA2
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS 81382
|
| Hospital Charge Code |
30000203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.93
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.44
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
OS HLA II TYPING 1 LOCUS LR
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 81376
|
| Hospital Charge Code |
30001839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem Medicaid |
$122.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.22
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Humana KY Medicaid |
$122.22
|
| Rate for Payer: Humana Medicare Advantage |
$122.22
|
| Rate for Payer: Kentucky WC Medicaid |
$123.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
OS HLA II TYPING 1 LOCUS LR
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 81376
|
| Hospital Charge Code |
30001839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.25
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
OS HOLLISTER HOUSE DUST IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000786
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS HOLLISTER HOUSE DUST IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000786
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS HOMOCYSTEINE
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
30000369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem Medicaid |
$17.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.92
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Humana KY Medicaid |
$17.92
|
| Rate for Payer: Humana Medicare Advantage |
$17.92
|
| Rate for Payer: Kentucky WC Medicaid |
$18.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
OS HOMOCYSTEINE
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
30000369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.25
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
OS HOMOVANILLIC ACID (HVA) U
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
30000370
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.10 |
| Max. Negotiated Rate |
$227.52 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$190.31
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$196.71
|
| Rate for Payer: First Health Commercial |
$225.15
|
| Rate for Payer: Humana Commercial |
$201.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$194.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$208.56
|
| Rate for Payer: Ohio Health Group HMO |
$177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.53
|
| Rate for Payer: PHCS Commercial |
$227.52
|
| Rate for Payer: United Healthcare All Payer |
$208.56
|
|
|
OS HOMOVANILLIC ACID (HVA) U
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
30000370
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$227.52 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Anthem Medicaid |
$22.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$190.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.41
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$196.71
|
| Rate for Payer: First Health Commercial |
$225.15
|
| Rate for Payer: Humana Commercial |
$201.45
|
| Rate for Payer: Humana KY Medicaid |
$22.41
|
| Rate for Payer: Humana Medicare Advantage |
$22.41
|
| Rate for Payer: Kentucky WC Medicaid |
$22.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$194.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$208.56
|
| Rate for Payer: Ohio Health Group HMO |
$177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.53
|
| Rate for Payer: PHCS Commercial |
$227.52
|
| Rate for Payer: United Healthcare All Payer |
$208.56
|
|
|
OS HONEYBEE VENOM IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
