|
OS HTLV I II AB CONFIRMATIO S
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
30001167
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.81
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$224.10
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Humana Commercial |
$229.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$221.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$199.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$237.60
|
| Rate for Payer: Ohio Health Group HMO |
$202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.30
|
| Rate for Payer: PHCS Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Payer |
$237.60
|
|
|
OS HTLV VIRUS ANTIBODY NOS
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
30001942
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$34.56 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.91
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$29.88
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: Humana Commercial |
$30.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.68
|
| Rate for Payer: Ohio Health Group HMO |
$27.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.84
|
| Rate for Payer: PHCS Commercial |
$34.56
|
| Rate for Payer: United Healthcare All Payer |
$31.68
|
|
|
OS HTLV VIRUS ANTIBODY NOS
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
30001942
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$34.56 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Anthem Medicaid |
$12.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$29.88
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: Humana Commercial |
$30.60
|
| Rate for Payer: Humana KY Medicaid |
$12.88
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Kentucky WC Medicaid |
$13.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.68
|
| Rate for Payer: Ohio Health Group HMO |
$27.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.84
|
| Rate for Payer: PHCS Commercial |
$34.56
|
| Rate for Payer: United Healthcare All Payer |
$31.68
|
|
|
OS HTR2C
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30001986
|
|
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 HTR2C
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30001986
|
|
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 Medicaid |
$63.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$63.97
|
| Rate for Payer: Kentucky WC Medicaid |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$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 HTT GENE DETC ABNOR ALLELES
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
HCPCS 81271
|
| Hospital Charge Code |
30001878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.70 |
| Max. Negotiated Rate |
$402.24 |
| Rate for Payer: Aetna Commercial |
$322.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.46
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Cigna Commercial |
$347.77
|
| Rate for Payer: First Health Commercial |
$398.05
|
| Rate for Payer: Humana Commercial |
$356.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$343.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$368.72
|
| Rate for Payer: Ohio Health Group HMO |
$314.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.11
|
| Rate for Payer: PHCS Commercial |
$402.24
|
| Rate for Payer: United Healthcare All Payer |
$368.72
|
|
|
OS HTT GENE DETC ABNOR ALLELES
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
HCPCS 81271
|
| Hospital Charge Code |
30001878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$402.24 |
| Rate for Payer: Aetna Commercial |
$322.63
|
| Rate for Payer: Anthem Medicaid |
$137.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$191.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.00
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Cigna Commercial |
$347.77
|
| Rate for Payer: First Health Commercial |
$398.05
|
| Rate for Payer: Humana Commercial |
$356.15
|
| Rate for Payer: Humana KY Medicaid |
$137.00
|
| Rate for Payer: Humana Medicare Advantage |
$137.00
|
| Rate for Payer: Kentucky WC Medicaid |
$138.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$343.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$368.72
|
| Rate for Payer: Ohio Health Group HMO |
$314.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.11
|
| Rate for Payer: PHCS Commercial |
$402.24
|
| Rate for Payer: United Healthcare All Payer |
$368.72
|
|
|
OS HUMAN EPIDIDYMIS PROTEIN 4
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 86305
|
| Hospital Charge Code |
30001850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem Medicaid |
$20.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Humana KY Medicaid |
$20.81
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Kentucky WC Medicaid |
$21.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
OS HUMAN EPIDIDYMIS PROTEIN 4
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 86305
|
| Hospital Charge Code |
30001850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.24
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
OS IA-2 AB S
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
30001073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$142.08 |
| Rate for Payer: Aetna Commercial |
$113.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.84
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$122.84
|
| Rate for Payer: First Health Commercial |
$140.60
|
| Rate for Payer: Humana Commercial |
$125.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.24
|
| Rate for Payer: Ohio Health Group HMO |
$111.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.12
|
| Rate for Payer: PHCS Commercial |
$142.08
|
| Rate for Payer: United Healthcare All Payer |
$130.24
|
|
|
OS IA-2 AB S
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
30001073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$142.08 |
| Rate for Payer: Aetna Commercial |
$113.96
|
| Rate for Payer: Anthem Medicaid |
$23.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.57
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$122.84
|
| Rate for Payer: First Health Commercial |
$140.60
|
| Rate for Payer: Humana Commercial |
$125.80
|
| Rate for Payer: Humana KY Medicaid |
$23.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.57
|
| Rate for Payer: Kentucky WC Medicaid |
$23.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.24
|
| Rate for Payer: Ohio Health Group HMO |
$111.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.12
|
| Rate for Payer: PHCS Commercial |
$142.08
|
| Rate for Payer: United Healthcare All Payer |
$130.24
|
|
|
OS ICAM
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000275
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS ICAM
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30000275
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$14.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.12
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Humana KY Medicaid |
$14.12
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$14.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS IgA, IgD, IgG, or IgM each
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
30000324
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna Commercial |
$12.37
|
| Rate for Payer: Ambetter Exchange |
$9.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$9.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$9.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$8.16
|
| Rate for Payer: Healthspan PPO |
$9.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.30
|
| Rate for Payer: Multiplan PHCS |
$138.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12.09
|
| Rate for Payer: UHCCP Medicaid |
$80.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
|
|
OS IgA, IgD, IgG, or IgM each
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
30000324
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: Aetna Commercial |
$177.87
|
| Rate for Payer: Anthem Medicaid |
$9.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$185.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.30
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$191.73
|
| Rate for Payer: First Health Commercial |
$219.45
|
| Rate for Payer: Humana Commercial |
$196.35
|
| Rate for Payer: Humana KY Medicaid |
$9.30
|
| Rate for Payer: Humana Medicare Advantage |
$9.30
|
| Rate for Payer: Kentucky WC Medicaid |
$9.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$189.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$170.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$203.28
|
| Rate for Payer: Ohio Health Group HMO |
$173.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.39
|
| Rate for Payer: PHCS Commercial |
$221.76
|
| Rate for Payer: United Healthcare All Payer |
$203.28
|
|
|
OS IgA, IgD, IgG, or IgM each
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
30000324
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: Aetna Commercial |
$177.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$185.49
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$191.73
|
| Rate for Payer: First Health Commercial |
$219.45
|
| Rate for Payer: Humana Commercial |
$196.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$189.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$170.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$203.28
|
| Rate for Payer: Ohio Health Group HMO |
$173.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.39
|
| Rate for Payer: PHCS Commercial |
$221.76
|
| Rate for Payer: United Healthcare All Payer |
$203.28
|
|
|
OS IGA SUBCLASSES 1
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
OS IGA SUBCLASSES 1
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$8.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.02
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$8.02
|
| Rate for Payer: Humana Medicare Advantage |
$8.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
OS IGA SUBCLASSES 2
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
OS IGA SUBCLASSES 2
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$8.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.02
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$8.02
|
| Rate for Payer: Humana Medicare Advantage |
$8.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
OS IGE TOTAL
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
30000326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$16.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.46
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$16.46
|
| Rate for Payer: Humana Medicare Advantage |
$16.46
|
| Rate for Payer: Kentucky WC Medicaid |
$16.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
OS IGE TOTAL
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
30000326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
OS IGFBP 3 SERUM
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.89
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
OS IGFBP 3 SERUM
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$108.60 |
| Rate for Payer: Aetna Commercial |
$30.27
|
| Rate for Payer: Ambetter Exchange |
$17.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$17.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$17.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.72
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$11.52
|
| Rate for Payer: Healthspan PPO |
$13.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.27
|
| Rate for Payer: Multiplan PHCS |
$108.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.45
|
| Rate for Payer: UHCCP Medicaid |
$63.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
|
|
OS IGFBP 3 SERUM
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.34
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.89
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
