|
OS MOPATH PROCEDURE LEVEL 1
|
Facility
|
OP
|
$548.70
|
|
|
Service Code
|
HCPCS 81400
|
| Hospital Charge Code |
30002018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$526.75 |
| Rate for Payer: Aetna Commercial |
$422.50
|
| Rate for Payer: Anthem Medicaid |
$63.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$63.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$89.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.96
|
| Rate for Payer: Cash Price |
$274.35
|
| Rate for Payer: Cash Price |
$274.35
|
| Rate for Payer: Cigna Commercial |
$455.42
|
| Rate for Payer: First Health Commercial |
$521.26
|
| Rate for Payer: Humana Commercial |
$466.39
|
| Rate for Payer: Humana KY Medicaid |
$63.96
|
| Rate for Payer: Humana Medicare Advantage |
$63.96
|
| Rate for Payer: Kentucky WC Medicaid |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.86
|
| Rate for Payer: Ohio Health Group HMO |
$411.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.60
|
| Rate for Payer: PHCS Commercial |
$526.75
|
| Rate for Payer: United Healthcare All Payer |
$482.86
|
|
|
OS MORPHINE UNCONJUGATED S
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| 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 |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS MORPHINE UNCONJUGATED S
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS MORPHINE UNCONJUGATED S
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS MORPHINE UNCONJUGATED S
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$59.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$59.84
|
| Rate for Payer: Kentucky WC Medicaid |
$60.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS MOSQUITO SPECIES IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000824
|
|
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 MOSQUITO SPECIES IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000824
|
|
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 MOTH IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000828
|
|
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 MOTH IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000828
|
|
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 MOUNTAIN CEDAR IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000951
|
|
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 MOUNTAIN CEDAR IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000951
|
|
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 M/PHMTRC ALYS ISHQUANT/SEMI
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS 88377
|
| Hospital Charge Code |
30001847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$937.92 |
| Rate for Payer: Aetna Commercial |
$752.29
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$784.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$488.50
|
| Rate for Payer: Cash Price |
$488.50
|
| Rate for Payer: Cigna Commercial |
$810.91
|
| Rate for Payer: First Health Commercial |
$928.15
|
| Rate for Payer: Humana Commercial |
$830.45
|
| Rate for Payer: Humana KY Medicaid |
$158.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.33
|
| Rate for Payer: Kentucky WC Medicaid |
$159.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$801.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$721.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$859.76
|
| Rate for Payer: Ohio Health Group HMO |
$732.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.13
|
| Rate for Payer: PHCS Commercial |
$937.92
|
| Rate for Payer: United Healthcare All Payer |
$859.76
|
|
|
OS M/PHMTRC ALYS ISHQUANT/SEMI
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS 88377
|
| Hospital Charge Code |
30001847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$293.10 |
| Max. Negotiated Rate |
$937.92 |
| Rate for Payer: Aetna Commercial |
$752.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$784.53
|
| Rate for Payer: Cash Price |
$488.50
|
| Rate for Payer: Cigna Commercial |
$810.91
|
| Rate for Payer: First Health Commercial |
$928.15
|
| Rate for Payer: Humana Commercial |
$830.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$801.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$721.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$859.76
|
| Rate for Payer: Ohio Health Group HMO |
$732.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.13
|
| Rate for Payer: PHCS Commercial |
$937.92
|
| Rate for Payer: United Healthcare All Payer |
$859.76
|
|
|
OS MPL EXON10 MUTATION DETECT
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
HCPCS 81339
|
| Hospital Charge Code |
30000207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$1,069.44 |
| Rate for Payer: Aetna Commercial |
$857.78
|
| Rate for Payer: Anthem Medicaid |
$185.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$894.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$259.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.20
|
| Rate for Payer: Cash Price |
$557.00
|
| Rate for Payer: Cash Price |
$557.00
|
| Rate for Payer: Cigna Commercial |
$924.62
|
| Rate for Payer: First Health Commercial |
$1,058.30
|
| Rate for Payer: Humana Commercial |
$946.90
|
| Rate for Payer: Humana KY Medicaid |
$185.20
|
| Rate for Payer: Humana Medicare Advantage |
$185.20
|
| Rate for Payer: Kentucky WC Medicaid |
$187.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.32
|
| Rate for Payer: Ohio Health Group HMO |
$835.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$969.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.66
|
| Rate for Payer: PHCS Commercial |
$1,069.44
|
| Rate for Payer: United Healthcare All Payer |
$980.32
|
|
|
OS MPL EXON10 MUTATION DETECT
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
HCPCS 81339
|
| Hospital Charge Code |
30000207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$334.20 |
| Max. Negotiated Rate |
$1,069.44 |
| Rate for Payer: Aetna Commercial |
$857.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$894.54
|
| Rate for Payer: Cash Price |
$557.00
|
| Rate for Payer: Cigna Commercial |
$924.62
|
| Rate for Payer: First Health Commercial |
$1,058.30
|
| Rate for Payer: Humana Commercial |
$946.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.32
|
| Rate for Payer: Ohio Health Group HMO |
$835.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$969.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.66
|
| Rate for Payer: PHCS Commercial |
$1,069.44
|
| Rate for Payer: United Healthcare All Payer |
$980.32
|
|
|
OS MTHFR ANTIDEPRESSANT
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
30000193
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.34 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem Medicaid |
$65.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$91.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.34
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Humana KY Medicaid |
$65.34
|
| Rate for Payer: Humana Medicare Advantage |
$65.34
|
| Rate for Payer: Kentucky WC Medicaid |
$65.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.10
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
OS MTHFR ANTIDEPRESSANT
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
30000193
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.57
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.10
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
OS M.TUBERCULO DNA AMP PROBE
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
30001964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.90 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna Commercial |
$225.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$235.28
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$243.19
|
| Rate for Payer: First Health Commercial |
$278.35
|
| Rate for Payer: Humana Commercial |
$249.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.84
|
| Rate for Payer: Ohio Health Group HMO |
$219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.17
|
| Rate for Payer: PHCS Commercial |
$281.28
|
| Rate for Payer: United Healthcare All Payer |
$257.84
|
|
|
OS M.TUBERCULO DNA AMP PROBE
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
30001964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna Commercial |
$225.61
|
| Rate for Payer: Anthem Medicaid |
$41.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$235.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$58.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.68
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$243.19
|
| Rate for Payer: First Health Commercial |
$278.35
|
| Rate for Payer: Humana Commercial |
$249.05
|
| Rate for Payer: Humana KY Medicaid |
$41.68
|
| Rate for Payer: Humana Medicare Advantage |
$41.68
|
| Rate for Payer: Kentucky WC Medicaid |
$42.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.84
|
| Rate for Payer: Ohio Health Group HMO |
$219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.17
|
| Rate for Payer: PHCS Commercial |
$281.28
|
| Rate for Payer: United Healthcare All Payer |
$257.84
|
|
|
OS MUCOR IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000759
|
|
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 MUCOR IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000759
|
|
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 MULBERRY IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000808
|
|
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 MULBERRY IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000808
|
|
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 MUMPS SCREEN
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
30001195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$349.44 |
| Rate for Payer: Aetna Commercial |
$280.28
|
| Rate for Payer: Anthem Medicaid |
$13.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$292.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.05
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$302.12
|
| Rate for Payer: First Health Commercial |
$345.80
|
| Rate for Payer: Humana Commercial |
$309.40
|
| Rate for Payer: Humana KY Medicaid |
$13.05
|
| Rate for Payer: Humana Medicare Advantage |
$13.05
|
| Rate for Payer: Kentucky WC Medicaid |
$13.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$320.32
|
| Rate for Payer: Ohio Health Group HMO |
$273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$291.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.16
|
| Rate for Payer: PHCS Commercial |
$349.44
|
| Rate for Payer: United Healthcare All Payer |
$320.32
|
|
|
OS MUMPS SCREEN
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
30001195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$349.44 |
| Rate for Payer: Aetna Commercial |
$280.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$292.29
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$302.12
|
| Rate for Payer: First Health Commercial |
$345.80
|
| Rate for Payer: Humana Commercial |
$309.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$320.32
|
| Rate for Payer: Ohio Health Group HMO |
$273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$291.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.16
|
| Rate for Payer: PHCS Commercial |
$349.44
|
| Rate for Payer: United Healthcare All Payer |
$320.32
|
|
