|
OS PROTEIN S ANTIGEN TOTAL
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
30000593
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$556.80 |
| Rate for Payer: Aetna Commercial |
$446.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$465.74
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$481.40
|
| Rate for Payer: First Health Commercial |
$551.00
|
| Rate for Payer: Humana Commercial |
$493.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$510.40
|
| Rate for Payer: Ohio Health Group HMO |
$435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$400.20
|
| Rate for Payer: PHCS Commercial |
$556.80
|
| Rate for Payer: United Healthcare All Payer |
$510.40
|
|
|
OS PROTEIN, SERUM, TOTAL
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
30001829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$3.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.67
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Humana KY Medicaid |
$3.67
|
| Rate for Payer: Humana Medicare Advantage |
$3.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
OS PROTEIN, SERUM, TOTAL
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
30001829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
OS PROTEIN TOTAL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
30000493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$3.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.67
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Humana KY Medicaid |
$3.67
|
| Rate for Payer: Humana Medicare Advantage |
$3.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
OS PROTEIN TOTAL
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
30000493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
OS PROTHROMBIN MUTATION
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
30001815
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$194.88 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.01
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cigna Commercial |
$168.49
|
| Rate for Payer: First Health Commercial |
$192.85
|
| Rate for Payer: Humana Commercial |
$172.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.64
|
| Rate for Payer: Ohio Health Group HMO |
$152.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.07
|
| Rate for Payer: PHCS Commercial |
$194.88
|
| Rate for Payer: United Healthcare All Payer |
$178.64
|
|
|
OS PROTHROMBIN MUTATION
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
30000186
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.69 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$65.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$91.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.69
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Humana KY Medicaid |
$65.69
|
| Rate for Payer: Humana Medicare Advantage |
$65.69
|
| Rate for Payer: Kentucky WC Medicaid |
$66.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
OS PROTHROMBIN MUTATION
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
30001815
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.69 |
| Max. Negotiated Rate |
$194.88 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Anthem Medicaid |
$65.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$91.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.69
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cigna Commercial |
$168.49
|
| Rate for Payer: First Health Commercial |
$192.85
|
| Rate for Payer: Humana Commercial |
$172.55
|
| Rate for Payer: Humana KY Medicaid |
$65.69
|
| Rate for Payer: Humana Medicare Advantage |
$65.69
|
| Rate for Payer: Kentucky WC Medicaid |
$66.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.64
|
| Rate for Payer: Ohio Health Group HMO |
$152.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.07
|
| Rate for Payer: PHCS Commercial |
$194.88
|
| Rate for Payer: United Healthcare All Payer |
$178.64
|
|
|
OS PROTHROMBIN MUTATION
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
30000186
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.66
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
OS PROTHROMBIN TIME
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
30000619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$210.24 |
| Rate for Payer: Aetna Commercial |
$168.63
|
| Rate for Payer: Anthem Medicaid |
$4.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.29
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cigna Commercial |
$181.77
|
| Rate for Payer: First Health Commercial |
$208.05
|
| Rate for Payer: Humana Commercial |
$186.15
|
| Rate for Payer: Humana KY Medicaid |
$4.29
|
| Rate for Payer: Humana Medicare Advantage |
$4.29
|
| Rate for Payer: Kentucky WC Medicaid |
$4.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$179.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$192.72
|
| Rate for Payer: Ohio Health Group HMO |
$164.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.11
|
| Rate for Payer: PHCS Commercial |
$210.24
|
| Rate for Payer: United Healthcare All Payer |
$192.72
|
|
|
OS PROTHROMBIN TIME
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
30000619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$210.24 |
| Rate for Payer: Aetna Commercial |
$168.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.86
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cigna Commercial |
$181.77
|
| Rate for Payer: First Health Commercial |
$208.05
|
| Rate for Payer: Humana Commercial |
$186.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$179.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$192.72
|
| Rate for Payer: Ohio Health Group HMO |
$164.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.11
|
| Rate for Payer: PHCS Commercial |
$210.24
|
| Rate for Payer: United Healthcare All Payer |
$192.72
|
|
|
OS PSA FREE
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
30000491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$18.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.39
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Humana KY Medicaid |
$18.39
|
| Rate for Payer: Humana Medicare Advantage |
$18.39
|
| Rate for Payer: Kentucky WC Medicaid |
$18.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.09
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS PSA FREE
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
30000491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.09
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
OS PSA TOTAL
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$18.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.39
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Humana KY Medicaid |
$18.39
|
| Rate for Payer: Humana Medicare Advantage |
$18.39
|
| Rate for Payer: Kentucky WC Medicaid |
$18.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
OS PSA TOTAL
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
OS PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 82480
|
| Hospital Charge Code |
30000282
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$7.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.87
|
| 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 |
$7.87
|
| Rate for Payer: Humana Medicare Advantage |
$7.87
|
| Rate for Payer: Kentucky WC Medicaid |
$7.95
|
| 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 |
$9.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.03
|
| 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 PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 82480
|
| Hospital Charge Code |
30000282
|
|
Hospital Revenue Code
|
300
|
| 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 PSYCH GENE PANEL
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30002005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem Medicaid |
$62.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.34
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Humana KY Medicaid |
$62.25
|
| Rate for Payer: Kentucky WC Medicaid |
$62.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.89
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
OS PSYCH GENE PANEL
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
30002005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.34
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.89
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
OS PT-Fibrinogen antigen
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 85385
|
| Hospital Charge Code |
30001796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$189.12 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem Medicaid |
$14.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.46
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Humana KY Medicaid |
$14.46
|
| Rate for Payer: Humana Medicare Advantage |
$14.46
|
| Rate for Payer: Kentucky WC Medicaid |
$14.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.93
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
OS PT-Fibrinogen antigen
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 85385
|
| Hospital Charge Code |
30001796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$189.12 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.19
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.93
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
OS PT-Fibrinogen antigen
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 85385
|
| Hospital Charge Code |
30001796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$118.20 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: Ambetter Exchange |
$14.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$14.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$14.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.35
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$7.44
|
| Rate for Payer: Healthspan PPO |
$8.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$14.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Multiplan PHCS |
$118.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.80
|
| Rate for Payer: UHCCP Medicaid |
$68.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.46
|
|
|
OS PT MIX 1:1
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
30000621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$169.92 |
| Rate for Payer: Aetna Commercial |
$136.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.13
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cigna Commercial |
$146.91
|
| Rate for Payer: First Health Commercial |
$168.15
|
| Rate for Payer: Humana Commercial |
$150.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$155.76
|
| Rate for Payer: Ohio Health Group HMO |
$132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.13
|
| Rate for Payer: PHCS Commercial |
$169.92
|
| Rate for Payer: United Healthcare All Payer |
$155.76
|
|
|
OS PT MIX 1:1
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
30000621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$169.92 |
| Rate for Payer: Aetna Commercial |
$136.29
|
| Rate for Payer: Anthem Medicaid |
$3.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.94
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cigna Commercial |
$146.91
|
| Rate for Payer: First Health Commercial |
$168.15
|
| Rate for Payer: Humana Commercial |
$150.45
|
| Rate for Payer: Humana KY Medicaid |
$3.94
|
| Rate for Payer: Humana Medicare Advantage |
$3.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$155.76
|
| Rate for Payer: Ohio Health Group HMO |
$132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.13
|
| Rate for Payer: PHCS Commercial |
$169.92
|
| Rate for Payer: United Healthcare All Payer |
$155.76
|
|
|
OS PT SUBST PLASMA FRAC EA
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
30000622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem Medicaid |
$3.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.94
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Humana KY Medicaid |
$3.94
|
| Rate for Payer: Humana Medicare Advantage |
$3.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.95
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
