|
OS SEROTONIN RELEASE ASSAY, UF
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30002027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$527.04 |
| Rate for Payer: Aetna Commercial |
$422.73
|
| Rate for Payer: Anthem Medicaid |
$24.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.09
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$455.67
|
| Rate for Payer: First Health Commercial |
$521.55
|
| Rate for Payer: Humana Commercial |
$466.65
|
| Rate for Payer: Humana KY Medicaid |
$24.09
|
| Rate for Payer: Humana Medicare Advantage |
$24.09
|
| Rate for Payer: Kentucky WC Medicaid |
$24.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$450.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$483.12
|
| Rate for Payer: Ohio Health Group HMO |
$411.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.81
|
| Rate for Payer: PHCS Commercial |
$527.04
|
| Rate for Payer: United Healthcare All Payer |
$483.12
|
|
|
OS SEROTONIN RELEASE ASSAY, UF
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30002027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$164.70 |
| Max. Negotiated Rate |
$527.04 |
| Rate for Payer: Aetna Commercial |
$422.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.85
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$455.67
|
| Rate for Payer: First Health Commercial |
$521.55
|
| Rate for Payer: Humana Commercial |
$466.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$450.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$483.12
|
| Rate for Payer: Ohio Health Group HMO |
$411.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.81
|
| Rate for Payer: PHCS Commercial |
$527.04
|
| Rate for Payer: United Healthcare All Payer |
$483.12
|
|
|
OS SEROTYPES 23
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86581
|
| Hospital Charge Code |
30001057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$4.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$4.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.66
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 23
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86581
|
| Hospital Charge Code |
30001057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.66
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SERPINA1 GENE
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 81332
|
| Hospital Charge Code |
30000196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.26
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
OS SERPINA1 GENE
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 81332
|
| Hospital Charge Code |
30000196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$43.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$43.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$61.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.65
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$43.65
|
| Rate for Payer: Humana Medicare Advantage |
$43.65
|
| Rate for Payer: Kentucky WC Medicaid |
$44.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
OS SEX HORMONE BINDING GLOB S
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 84270
|
| Hospital Charge Code |
30000510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$21.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.73
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Humana KY Medicaid |
$21.73
|
| Rate for Payer: Humana Medicare Advantage |
$21.73
|
| Rate for Payer: Kentucky WC Medicaid |
$21.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OS SEX HORMONE BINDING GLOB S
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 84270
|
| Hospital Charge Code |
30000510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OS SGPG IGM INDEX
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000411
|
|
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 SGPG IGM INDEX
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| 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 |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| 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 |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| 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 SILVER BIRCH
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30001958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| 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 |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
OS SILVER BIRCH
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30001958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
OSSIOFIBER FIXATION SYS 2.5X16
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
OSSIOFIBER FIXATION SYS 2.5X16
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
OSSIO FIX SYST 2.9*19MM ST 0^
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
OSSIO FIX SYST 2.9*19MM ST 0^
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
OS SMPD1 GENE COMMON VARIANTS
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 81330
|
| Hospital Charge Code |
30001918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$47.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$47.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Humana KY Medicaid |
$47.00
|
| Rate for Payer: Humana Medicare Advantage |
$47.00
|
| Rate for Payer: Kentucky WC Medicaid |
$47.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS SMPD1 GENE COMMON VARIANTS
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 81330
|
| Hospital Charge Code |
30001918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OS SODIUM FECES
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
30000513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS SODIUM FECES
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
30000513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$4.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.86
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$4.86
|
| Rate for Payer: Humana Medicare Advantage |
$4.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS SOLUBLE FIBRIN MONOMER
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 85366
|
| Hospital Charge Code |
30000600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$378.24 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: Anthem Medicaid |
$80.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$80.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$316.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$112.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$80.46
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$327.02
|
| Rate for Payer: First Health Commercial |
$374.30
|
| Rate for Payer: Humana Commercial |
$334.90
|
| Rate for Payer: Humana KY Medicaid |
$80.46
|
| Rate for Payer: Humana Medicare Advantage |
$80.46
|
| Rate for Payer: Kentucky WC Medicaid |
$81.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
| Rate for Payer: Ohio Health Group HMO |
$295.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$342.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.86
|
| Rate for Payer: PHCS Commercial |
$378.24
|
| Rate for Payer: United Healthcare All Payer |
$346.72
|
|
|
OS SOLUBLE FIBRIN MONOMER
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 85366
|
| Hospital Charge Code |
30000600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$378.24 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$316.38
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$327.02
|
| Rate for Payer: First Health Commercial |
$374.30
|
| Rate for Payer: Humana Commercial |
$334.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
| Rate for Payer: Ohio Health Group HMO |
$295.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$342.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.86
|
| Rate for Payer: PHCS Commercial |
$378.24
|
| Rate for Payer: United Healthcare All Payer |
$346.72
|
|
|
OS SOLUBL TRANSFERRIN RECEPTOR
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 84238
|
| Hospital Charge Code |
30001774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.57 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$36.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$36.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$51.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.57
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$36.57
|
| Rate for Payer: Humana Medicare Advantage |
$36.57
|
| Rate for Payer: Kentucky WC Medicaid |
$36.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS SOLUBL TRANSFERRIN RECEPTOR
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 84238
|
| Hospital Charge Code |
30001774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS SOMA CYCLOBENZAPRINE MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80369
|
| Hospital Charge Code |
30000165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
