|
OS Mat21 FETAL CHROMO MICRODEL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 81422
|
| Hospital Charge Code |
30001781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
OS Mat21 FETAL CHROMO MICRODEL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 81422
|
| Hospital Charge Code |
30001781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$1,062.67 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem Medicaid |
$759.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,062.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.05
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Humana KY Medicaid |
$759.05
|
| Rate for Payer: Humana Medicare Advantage |
$759.05
|
| Rate for Payer: Kentucky WC Medicaid |
$766.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
OS MATERNIT21PRENATAL TEST
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$986.76 |
| Rate for Payer: Ambetter Exchange |
$759.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$759.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$759.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$910.86
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$759.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.05
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$986.76
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$759.05
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
OP
|
$869.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$599.61 |
| Max. Negotiated Rate |
$1,062.67 |
| Rate for Payer: Aetna Commercial |
$669.13
|
| Rate for Payer: Anthem Medicaid |
$759.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,062.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.05
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$721.27
|
| Rate for Payer: First Health Commercial |
$825.55
|
| Rate for Payer: Humana Commercial |
$738.65
|
| Rate for Payer: Humana KY Medicaid |
$759.05
|
| Rate for Payer: Humana Medicare Advantage |
$759.05
|
| Rate for Payer: Kentucky WC Medicaid |
$766.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$712.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$641.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$764.72
|
| Rate for Payer: Ohio Health Group HMO |
$651.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.61
|
| Rate for Payer: PHCS Commercial |
$834.24
|
| Rate for Payer: United Healthcare All Payer |
$764.72
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30002084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$260.70 |
| Max. Negotiated Rate |
$834.24 |
| Rate for Payer: Aetna Commercial |
$669.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.81
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$721.27
|
| Rate for Payer: First Health Commercial |
$825.55
|
| Rate for Payer: Humana Commercial |
$738.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$712.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$641.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$764.72
|
| Rate for Payer: Ohio Health Group HMO |
$651.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.61
|
| Rate for Payer: PHCS Commercial |
$834.24
|
| Rate for Payer: United Healthcare All Payer |
$764.72
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30000210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$617.55 |
| Max. Negotiated Rate |
$1,062.67 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Anthem Medicaid |
$759.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$718.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,062.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.05
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$742.85
|
| Rate for Payer: First Health Commercial |
$850.25
|
| Rate for Payer: Humana Commercial |
$760.75
|
| Rate for Payer: Humana KY Medicaid |
$759.05
|
| Rate for Payer: Humana Medicare Advantage |
$759.05
|
| Rate for Payer: Kentucky WC Medicaid |
$766.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$660.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$787.60
|
| Rate for Payer: Ohio Health Group HMO |
$671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$778.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.55
|
| Rate for Payer: PHCS Commercial |
$859.20
|
| Rate for Payer: United Healthcare All Payer |
$787.60
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$617.55 |
| Max. Negotiated Rate |
$1,062.67 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Anthem Medicaid |
$759.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$718.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,062.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.05
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$742.85
|
| Rate for Payer: First Health Commercial |
$850.25
|
| Rate for Payer: Humana Commercial |
$760.75
|
| Rate for Payer: Humana KY Medicaid |
$759.05
|
| Rate for Payer: Humana Medicare Advantage |
$759.05
|
| Rate for Payer: Kentucky WC Medicaid |
$766.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$660.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$787.60
|
| Rate for Payer: Ohio Health Group HMO |
$671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$778.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.55
|
| Rate for Payer: PHCS Commercial |
$859.20
|
| Rate for Payer: United Healthcare All Payer |
$787.60
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30000210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$268.50 |
| Max. Negotiated Rate |
$859.20 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$718.68
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$742.85
|
| Rate for Payer: First Health Commercial |
$850.25
|
| Rate for Payer: Humana Commercial |
$760.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$660.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$787.60
|
| Rate for Payer: Ohio Health Group HMO |
$671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$778.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.55
|
| Rate for Payer: PHCS Commercial |
$859.20
|
| Rate for Payer: United Healthcare All Payer |
$787.60
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$268.50 |
| Max. Negotiated Rate |
$859.20 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$718.68
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$742.85
|
| Rate for Payer: First Health Commercial |
$850.25
|
| Rate for Payer: Humana Commercial |
$760.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$660.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$787.60
|
| Rate for Payer: Ohio Health Group HMO |
$671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$778.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.55
|
| Rate for Payer: PHCS Commercial |
$859.20
|
| Rate for Payer: United Healthcare All Payer |
$787.60
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
OP
|
$869.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30002084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$599.61 |
| Max. Negotiated Rate |
$1,062.67 |
| Rate for Payer: Aetna Commercial |
$669.13
|
| Rate for Payer: Anthem Medicaid |
$759.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,062.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.05
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$721.27
|
| Rate for Payer: First Health Commercial |
$825.55
|
| Rate for Payer: Humana Commercial |
$738.65
|
| Rate for Payer: Humana KY Medicaid |
$759.05
|
| Rate for Payer: Humana Medicare Advantage |
$759.05
|
| Rate for Payer: Kentucky WC Medicaid |
$766.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$712.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$641.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$764.72
|
| Rate for Payer: Ohio Health Group HMO |
$651.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.61
|
| Rate for Payer: PHCS Commercial |
$834.24
|
| Rate for Payer: United Healthcare All Payer |
$764.72
|
|
|
OS MATERNIT21PRENATAL TEST
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$313.25 |
| Max. Negotiated Rate |
$986.76 |
| Rate for Payer: Ambetter Exchange |
$759.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$759.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$759.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$910.86
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$759.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.05
|
| Rate for Payer: Multiplan PHCS |
$537.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$986.76
|
| Rate for Payer: UHCCP Medicaid |
$313.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$759.05
|
|
|
OS MATERNIT21PRENATAL TEST
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30000210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$313.25 |
| Max. Negotiated Rate |
$986.76 |
| Rate for Payer: Ambetter Exchange |
$759.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$759.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$759.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$910.86
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$759.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.05
|
| Rate for Payer: Multiplan PHCS |
$537.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$986.76
|
| Rate for Payer: UHCCP Medicaid |
$313.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$759.05
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$260.70 |
| Max. Negotiated Rate |
$834.24 |
| Rate for Payer: Aetna Commercial |
$669.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.81
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$721.27
|
| Rate for Payer: First Health Commercial |
$825.55
|
| Rate for Payer: Humana Commercial |
$738.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$712.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$641.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$764.72
|
| Rate for Payer: Ohio Health Group HMO |
$651.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.61
|
| Rate for Payer: PHCS Commercial |
$834.24
|
| Rate for Payer: United Healthcare All Payer |
$764.72
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$579.60 |
| Max. Negotiated Rate |
$1,062.67 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$759.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,062.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.05
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$759.05
|
| Rate for Payer: Humana Medicare Advantage |
$759.05
|
| Rate for Payer: Kentucky WC Medicaid |
$766.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
OS MATERNIT21PRENATAL TEST
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
30001813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.52
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
OS MCOLN1 GENE
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 81290
|
| Hospital Charge Code |
30001917
|
|
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 MCOLN1 GENE
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 81290
|
| Hospital Charge Code |
30001917
|
|
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 MCR CORD DRUG PANEL
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001554
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| 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 |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.12
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS MCR CORD DRUG PANEL
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001554
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.12
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS MCR URINE COM DRUG SCREEN
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$234.24 |
| Rate for Payer: Aetna Commercial |
$187.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.93
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cigna Commercial |
$202.52
|
| Rate for Payer: First Health Commercial |
$231.80
|
| Rate for Payer: Humana Commercial |
$207.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$214.72
|
| Rate for Payer: Ohio Health Group HMO |
$183.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.36
|
| Rate for Payer: PHCS Commercial |
$234.24
|
| Rate for Payer: United Healthcare All Payer |
$214.72
|
|
|
OS MCR URINE COM DRUG SCREEN
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$234.24 |
| Rate for Payer: Aetna Commercial |
$187.88
|
| Rate for Payer: Anthem Medicaid |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cigna Commercial |
$202.52
|
| Rate for Payer: First Health Commercial |
$231.80
|
| Rate for Payer: Humana Commercial |
$207.40
|
| Rate for Payer: Humana KY Medicaid |
$62.14
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Kentucky WC Medicaid |
$62.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$214.72
|
| Rate for Payer: Ohio Health Group HMO |
$183.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.36
|
| Rate for Payer: PHCS Commercial |
$234.24
|
| Rate for Payer: United Healthcare All Payer |
$214.72
|
|
|
OS MCR URINE DRUG SCREEN
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
30001556
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$698.88 |
| Rate for Payer: Aetna Commercial |
$560.56
|
| Rate for Payer: Anthem Medicaid |
$246.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$246.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$584.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$345.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$246.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$604.24
|
| Rate for Payer: First Health Commercial |
$691.60
|
| Rate for Payer: Humana Commercial |
$618.80
|
| Rate for Payer: Humana KY Medicaid |
$246.92
|
| Rate for Payer: Humana Medicare Advantage |
$246.92
|
| Rate for Payer: Kentucky WC Medicaid |
$249.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$596.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$537.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$296.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$251.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$640.64
|
| Rate for Payer: Ohio Health Group HMO |
$546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$582.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$502.32
|
| Rate for Payer: PHCS Commercial |
$698.88
|
| Rate for Payer: United Healthcare All Payer |
$640.64
|
|
|
OS MCR URINE DRUG SCREEN
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
30001556
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$698.88 |
| Rate for Payer: Aetna Commercial |
$560.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$584.58
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$604.24
|
| Rate for Payer: First Health Commercial |
$691.60
|
| Rate for Payer: Humana Commercial |
$618.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$596.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$537.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$218.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$640.64
|
| Rate for Payer: Ohio Health Group HMO |
$546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$582.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$502.32
|
| Rate for Payer: PHCS Commercial |
$698.88
|
| Rate for Payer: United Healthcare All Payer |
$640.64
|
|
|
OS MDA MDEA MDMA
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 80359
|
| Hospital Charge Code |
30000145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
OS MDA MDEA MDMA
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| 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 |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
