|
OS IGG SUBCLASSES 1
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000331
|
|
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 IGG SUBCLASSES 1
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000331
|
|
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 IGG SUBCLASSES 2
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000332
|
|
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 IGG SUBCLASSES 2
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000332
|
|
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 IGG SUBCLASSES 3
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000330
|
|
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 IGG SUBCLASSES 3
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000330
|
|
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 IGG SUBCLASSES 4
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000327
|
|
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 IGG SUBCLASSES 4
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
30000327
|
|
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 IGH GENE REARRANGE AMP METH
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 81261
|
| Hospital Charge Code |
30001855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$197.99 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem Medicaid |
$197.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$197.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$277.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$197.99
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Humana KY Medicaid |
$197.99
|
| Rate for Payer: Humana Medicare Advantage |
$197.99
|
| Rate for Payer: Kentucky WC Medicaid |
$199.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.25
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
OS IGH GENE REARRANGE AMP METH
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 81261
|
| Hospital Charge Code |
30001855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.27
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.25
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
OS IGH VARI REGIONAL MUTATION
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
HCPCS 81263
|
| Hospital Charge Code |
30001883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$311.10 |
| Max. Negotiated Rate |
$995.52 |
| Rate for Payer: Aetna Commercial |
$798.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$832.71
|
| Rate for Payer: Cash Price |
$518.50
|
| Rate for Payer: Cigna Commercial |
$860.71
|
| Rate for Payer: First Health Commercial |
$985.15
|
| Rate for Payer: Humana Commercial |
$881.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$850.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$765.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$311.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$912.56
|
| Rate for Payer: Ohio Health Group HMO |
$777.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$902.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$715.53
|
| Rate for Payer: PHCS Commercial |
$995.52
|
| Rate for Payer: United Healthcare All Payer |
$912.56
|
|
|
OS IGH VARI REGIONAL MUTATION
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
HCPCS 81263
|
| Hospital Charge Code |
30001883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.52 |
| Max. Negotiated Rate |
$995.52 |
| Rate for Payer: Aetna Commercial |
$798.49
|
| Rate for Payer: Anthem Medicaid |
$294.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$294.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$832.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$412.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$294.52
|
| Rate for Payer: Cash Price |
$518.50
|
| Rate for Payer: Cash Price |
$518.50
|
| Rate for Payer: Cigna Commercial |
$860.71
|
| Rate for Payer: First Health Commercial |
$985.15
|
| Rate for Payer: Humana Commercial |
$881.45
|
| Rate for Payer: Humana KY Medicaid |
$294.52
|
| Rate for Payer: Humana Medicare Advantage |
$294.52
|
| Rate for Payer: Kentucky WC Medicaid |
$297.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$850.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$765.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$353.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$300.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$912.56
|
| Rate for Payer: Ohio Health Group HMO |
$777.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$902.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$715.53
|
| Rate for Payer: PHCS Commercial |
$995.52
|
| Rate for Payer: United Healthcare All Payer |
$912.56
|
|
|
OS IGK REARRANGEABN CLONAL POP
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 81264
|
| Hospital Charge Code |
30001854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.73 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem Medicaid |
$172.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.73
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Humana KY Medicaid |
$172.73
|
| Rate for Payer: Humana Medicare Advantage |
$172.73
|
| Rate for Payer: Kentucky WC Medicaid |
$174.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.25
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
OS IGK REARRANGEABN CLONAL POP
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 81264
|
| Hospital Charge Code |
30001854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.27
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.25
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
OS IG PARAPROTEIN QUAL BLD/UR
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 0077U
|
| Hospital Charge Code |
30001944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
OS IG PARAPROTEIN QUAL BLD/UR
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 0077U
|
| Hospital Charge Code |
30001944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.43 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$43.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$43.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$60.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.43
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$43.43
|
| Rate for Payer: Humana Medicare Advantage |
$43.43
|
| Rate for Payer: Kentucky WC Medicaid |
$43.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
OS IHC MULTIPLEX
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 88344
|
| Hospital Charge Code |
30002004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$278.07 |
| Max. Negotiated Rate |
$465.32 |
| Rate for Payer: Aetna Commercial |
$310.31
|
| Rate for Payer: Anthem Medicaid |
$332.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$332.37
|
| 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 |
$332.37
|
| Rate for Payer: Humana Medicare Advantage |
$332.37
|
| Rate for Payer: Kentucky WC Medicaid |
$335.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$330.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$297.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.02
|
| 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 IHC MULTIPLEX
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 88344
|
| Hospital Charge Code |
30002004
|
|
Hospital Revenue Code
|
310
|
| 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 IKBKAP GENE
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 81260
|
| Hospital Charge Code |
30001916
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$55.03 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$39.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$55.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.31
|
| 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 |
$39.31
|
| Rate for Payer: Humana Medicare Advantage |
$39.31
|
| Rate for Payer: Kentucky WC Medicaid |
$39.70
|
| 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 |
$47.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.10
|
| 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 IKBKAP GENE
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 81260
|
| Hospital Charge Code |
30001916
|
|
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 IL28B POLYMORPHIS
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$435.84 |
| Rate for Payer: Aetna Commercial |
$349.58
|
| Rate for Payer: Anthem Medicaid |
$156.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.56
|
| Rate for Payer: Cash Price |
$227.00
|
| Rate for Payer: Cigna Commercial |
$376.82
|
| Rate for Payer: First Health Commercial |
$431.30
|
| Rate for Payer: Humana Commercial |
$385.90
|
| Rate for Payer: Humana KY Medicaid |
$156.13
|
| Rate for Payer: Kentucky WC Medicaid |
$157.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$372.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$399.52
|
| Rate for Payer: Ohio Health Group HMO |
$340.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.26
|
| Rate for Payer: PHCS Commercial |
$435.84
|
| Rate for Payer: United Healthcare All Payer |
$399.52
|
|
|
OS IL28B POLYMORPHIS
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30000212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$435.84 |
| Rate for Payer: Aetna Commercial |
$349.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.56
|
| Rate for Payer: Cash Price |
$227.00
|
| Rate for Payer: Cigna Commercial |
$376.82
|
| Rate for Payer: First Health Commercial |
$431.30
|
| Rate for Payer: Humana Commercial |
$385.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$372.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$399.52
|
| Rate for Payer: Ohio Health Group HMO |
$340.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.26
|
| Rate for Payer: PHCS Commercial |
$435.84
|
| Rate for Payer: United Healthcare All Payer |
$399.52
|
|
|
OS IMIPRAMINE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
30000093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
OS IMIPRAMINE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
30000093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$18.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$18.91
|
| Rate for Payer: Kentucky WC Medicaid |
$19.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
OS IMIPRAMINE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
