|
OS LIDOCAINE PLASMA
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 80176
|
| Hospital Charge Code |
30000035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
OS LIDOCAINE PLASMA
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 80176
|
| Hospital Charge Code |
30000035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem Medicaid |
$14.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.69
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Humana KY Medicaid |
$14.69
|
| Rate for Payer: Humana Medicare Advantage |
$14.69
|
| Rate for Payer: Kentucky WC Medicaid |
$14.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
OS LIPID PANEL
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.47
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.95
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
OS LIPID PANEL
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem Medicaid |
$13.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Humana KY Medicaid |
$13.39
|
| Rate for Payer: Humana Medicare Advantage |
$13.39
|
| Rate for Payer: Kentucky WC Medicaid |
$13.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.95
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
OS LIPOPROTEIN A SERUM
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 83695
|
| Hospital Charge Code |
30000421
|
|
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
|
|
|
OS LIPOPROTEIN A SERUM
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 83695
|
| Hospital Charge Code |
30000421
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem Medicaid |
$14.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.32
|
| 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 |
$14.32
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$14.46
|
| 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 |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.61
|
| 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 LIPOPROTEIN PLA2
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 83698
|
| Hospital Charge Code |
30001950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.33
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
OS LIPOPROTEIN PLA2
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 83698
|
| Hospital Charge Code |
30001950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.33 |
| Max. Negotiated Rate |
$64.83 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$46.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$64.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.31
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$46.31
|
| Rate for Payer: Humana Medicare Advantage |
$46.31
|
| Rate for Payer: Kentucky WC Medicaid |
$46.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.33
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
OS LSD CONFIRMATION URINE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 80323
|
| Hospital Charge Code |
30000081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$53.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Humana KY Medicaid |
$53.65
|
| Rate for Payer: Kentucky WC Medicaid |
$54.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.64
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS LSD CONFIRMATION URINE
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 80323
|
| Hospital Charge Code |
30000081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.64
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS LSD CONFIRMATION URINE
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.64
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS LSD CONFIRMATION URINE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| 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 |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.64
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS LUPINE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000788
|
|
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 LUPINE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000788
|
|
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 LVER/KDNEY MICROS TYP 1 AB
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.18
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
OS LVER/KDNEY MICROS TYP 1 AB
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem Medicaid |
$14.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Humana KY Medicaid |
$14.55
|
| Rate for Payer: Humana Medicare Advantage |
$14.55
|
| Rate for Payer: Kentucky WC Medicaid |
$14.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
OS LYME DISEASE AB CONF CSF
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.90 |
| Max. Negotiated Rate |
$166.08 |
| Rate for Payer: Aetna Commercial |
$133.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.92
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$143.59
|
| Rate for Payer: First Health Commercial |
$164.35
|
| Rate for Payer: Humana Commercial |
$147.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$127.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$152.24
|
| Rate for Payer: Ohio Health Group HMO |
$129.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.37
|
| Rate for Payer: PHCS Commercial |
$166.08
|
| Rate for Payer: United Healthcare All Payer |
$152.24
|
|
|
OS LYME DISEASE AB CONF CSF
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$166.08 |
| Rate for Payer: Aetna Commercial |
$133.21
|
| Rate for Payer: Anthem Medicaid |
$15.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.49
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$143.59
|
| Rate for Payer: First Health Commercial |
$164.35
|
| Rate for Payer: Humana Commercial |
$147.05
|
| Rate for Payer: Humana KY Medicaid |
$15.49
|
| Rate for Payer: Humana Medicare Advantage |
$15.49
|
| Rate for Payer: Kentucky WC Medicaid |
$15.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$127.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$152.24
|
| Rate for Payer: Ohio Health Group HMO |
$129.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.37
|
| Rate for Payer: PHCS Commercial |
$166.08
|
| Rate for Payer: United Healthcare All Payer |
$152.24
|
|
|
OS LYME DISEASE AB IGG
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001120
|
|
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 LYME DISEASE AB IGG
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$15.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.49
|
| 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 |
$15.49
|
| Rate for Payer: Humana Medicare Advantage |
$15.49
|
| Rate for Payer: Kentucky WC Medicaid |
$15.64
|
| 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 |
$18.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.80
|
| 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 LYME DISEASE AB IGM
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001121
|
|
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 LYME DISEASE AB IGM
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
30001121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$15.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.49
|
| 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 |
$15.49
|
| Rate for Payer: Humana Medicare Advantage |
$15.49
|
| Rate for Payer: Kentucky WC Medicaid |
$15.64
|
| 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 |
$18.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.80
|
| 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 LYME DISEASE CSF PCR
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
30001362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$316.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$184.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
OS LYME DISEASE CSF PCR
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
30001362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.98
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
OS LYME DISEASE CSF PCR
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
30001362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| 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 |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
