|
OS MICRODISSECTION LASER
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS 88380
|
| Hospital Charge Code |
30001860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$402.90 |
| Max. Negotiated Rate |
$1,289.28 |
| Rate for Payer: Aetna Commercial |
$1,034.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,078.43
|
| Rate for Payer: Cash Price |
$671.50
|
| Rate for Payer: Cigna Commercial |
$1,114.69
|
| Rate for Payer: First Health Commercial |
$1,275.85
|
| Rate for Payer: Humana Commercial |
$1,141.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,101.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$991.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,181.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,007.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,074.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$926.67
|
| Rate for Payer: PHCS Commercial |
$1,289.28
|
| Rate for Payer: United Healthcare All Payer |
$1,181.84
|
|
|
OS MICRODISSECTION MANUAL
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 88381
|
| Hospital Charge Code |
30001993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$78.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$78.07
|
| Rate for Payer: Kentucky WC Medicaid |
$78.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
OS MICRODISSECTION MANUAL
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 88381
|
| Hospital Charge Code |
30001993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
OS MICROSLIDE CONSULTATION
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
30001517
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$165.90 |
| Max. Negotiated Rate |
$530.88 |
| Rate for Payer: Aetna Commercial |
$425.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$444.06
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cigna Commercial |
$458.99
|
| Rate for Payer: First Health Commercial |
$525.35
|
| Rate for Payer: Humana Commercial |
$470.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.64
|
| Rate for Payer: Ohio Health Group HMO |
$414.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.57
|
| Rate for Payer: PHCS Commercial |
$530.88
|
| Rate for Payer: United Healthcare All Payer |
$486.64
|
|
|
OS MICROSLIDE CONSULTATION
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
30001517
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$530.88 |
| Rate for Payer: Aetna Commercial |
$425.81
|
| Rate for Payer: Anthem Medicaid |
$36.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$36.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$444.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$50.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.27
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cigna Commercial |
$458.99
|
| Rate for Payer: First Health Commercial |
$525.35
|
| Rate for Payer: Humana Commercial |
$470.05
|
| Rate for Payer: Humana KY Medicaid |
$36.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.27
|
| Rate for Payer: Kentucky WC Medicaid |
$36.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.64
|
| Rate for Payer: Ohio Health Group HMO |
$414.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.57
|
| Rate for Payer: PHCS Commercial |
$530.88
|
| Rate for Payer: United Healthcare All Payer |
$486.64
|
|
|
OS MICROSOMAL ANTI
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
OS MICROSOMAL ANTI
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem Medicaid |
$14.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| 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 |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
OS MICROSOMAL ANTIBODY EACH
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem Medicaid |
$14.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| 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 |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.98
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
OS MICROSOMAL ANTIBODY EACH
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.98
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
OS MILK GOAT IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000777
|
|
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 MILK GOAT IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000777
|
|
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 MILK PROCESSED IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000742
|
|
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 MILK PROCESSED IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000742
|
|
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 MILLENNIUM DRUG TESTING
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| 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 |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
OS MILLENNIUM DRUG TESTING
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
OS MILLENNIUM DRUG TESTING MC
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
30001557
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.70 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$461.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$481.00
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$497.17
|
| Rate for Payer: First Health Commercial |
$569.05
|
| Rate for Payer: Humana Commercial |
$509.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.12
|
| Rate for Payer: Ohio Health Group HMO |
$449.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.31
|
| Rate for Payer: PHCS Commercial |
$575.04
|
| Rate for Payer: United Healthcare All Payer |
$527.12
|
|
|
OS MILLENNIUM DRUG TESTING MC
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
30001557
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$461.23
|
| Rate for Payer: Anthem Medicaid |
$246.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$246.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$481.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$345.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$246.92
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$497.17
|
| Rate for Payer: First Health Commercial |
$569.05
|
| Rate for Payer: Humana Commercial |
$509.15
|
| 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 |
$491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$296.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$251.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.12
|
| Rate for Payer: Ohio Health Group HMO |
$449.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.31
|
| Rate for Payer: PHCS Commercial |
$575.04
|
| Rate for Payer: United Healthcare All Payer |
$527.12
|
|
|
OS MITOCHONDRIAL AB M2 S
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 86381
|
| Hospital Charge Code |
30000382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$25.45
|
| Rate for Payer: Humana Medicare Advantage |
$25.45
|
| Rate for Payer: Kentucky WC Medicaid |
$25.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.61
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
OS MITOCHONDRIAL AB M2 S
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 86381
|
| Hospital Charge Code |
30000382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.71
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.61
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
OS MITOCHONDRIAL AB SCREEN
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.81
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS MITOCHONDRIAL AB SCREEN
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.81
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS MITOCHONDRIAL AB TITER
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
30001020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.33
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
OS MITOCHONDRIAL AB TITER
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
30001020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.07
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.33
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
OS MOG-IGG1 ANTB EACH
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
HCPCS 86362
|
| Hospital Charge Code |
30002083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$1,020.48 |
| Rate for Payer: Aetna Commercial |
$818.51
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$853.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$531.50
|
| Rate for Payer: Cash Price |
$531.50
|
| Rate for Payer: Cigna Commercial |
$882.29
|
| Rate for Payer: First Health Commercial |
$1,009.85
|
| Rate for Payer: Humana Commercial |
$903.55
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$871.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$784.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$935.44
|
| Rate for Payer: Ohio Health Group HMO |
$797.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$850.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$733.47
|
| Rate for Payer: PHCS Commercial |
$1,020.48
|
| Rate for Payer: United Healthcare All Payer |
$935.44
|
|
|
OS MOG-IGG1 ANTB EACH
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
HCPCS 86362
|
| Hospital Charge Code |
30002083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$318.90 |
| Max. Negotiated Rate |
$1,020.48 |
| Rate for Payer: Aetna Commercial |
$818.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$853.59
|
| Rate for Payer: Cash Price |
$531.50
|
| Rate for Payer: Cigna Commercial |
$882.29
|
| Rate for Payer: First Health Commercial |
$1,009.85
|
| Rate for Payer: Humana Commercial |
$903.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$871.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$784.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$935.44
|
| Rate for Payer: Ohio Health Group HMO |
$797.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$850.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$733.47
|
| Rate for Payer: PHCS Commercial |
$1,020.48
|
| Rate for Payer: United Healthcare All Payer |
$935.44
|
|
