|
OS THYROGLOBULIN TUMOR MARK S
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 84432
|
| Hospital Charge Code |
30000525
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.95
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
OS THYROGLOBULIN TUMOR MARK S
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 84432
|
| Hospital Charge Code |
30000525
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem Medicaid |
$16.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.06
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Humana KY Medicaid |
$16.06
|
| Rate for Payer: Humana Medicare Advantage |
$16.06
|
| Rate for Payer: Kentucky WC Medicaid |
$16.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
OS THYROID STIMULATING IMM TSI
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 84445
|
| Hospital Charge Code |
30000532
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$184.50 |
| Max. Negotiated Rate |
$590.40 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.85
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.35
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
OS THYROID STIMULATING IMM TSI
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 84445
|
| Hospital Charge Code |
30000532
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$590.40 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem Medicaid |
$50.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$50.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$50.86
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Humana KY Medicaid |
$50.86
|
| Rate for Payer: Humana Medicare Advantage |
$50.86
|
| Rate for Payer: Kentucky WC Medicaid |
$51.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.35
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
OS THYROPEROXIDASE (TPO) AB
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
OS THYROPEROXIDASE (TPO) AB
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem Medicaid |
$14.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Humana KY Medicaid |
$14.55
|
| Rate for Payer: Humana Medicare Advantage |
$14.55
|
| Rate for Payer: Kentucky WC Medicaid |
$14.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
OS THYROTROPIN RECEPTOR AB S
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
30000392
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.36
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.88
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
OS THYROTROPIN RECEPTOR AB S
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
30000392
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem Medicaid |
$18.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.40
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Humana KY Medicaid |
$18.40
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Kentucky WC Medicaid |
$18.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.88
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
OS THYROXINE BIND GLOBULIN S
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 84442
|
| Hospital Charge Code |
30000529
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem Medicaid |
$14.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.78
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Humana KY Medicaid |
$14.78
|
| Rate for Payer: Humana Medicare Advantage |
$14.78
|
| Rate for Payer: Kentucky WC Medicaid |
$14.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
OS THYROXINE BIND GLOBULIN S
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 84442
|
| Hospital Charge Code |
30000529
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.80
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
OS THYROXINE BINDING CAPACITY
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
30001590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem Medicaid |
$6.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Humana KY Medicaid |
$6.47
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.30
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
OS THYROXINE BINDING CAPACITY
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
30001590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.51
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.30
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
OSTIAL 10FR CANNULA BIO TRONIC
|
Facility
|
IP
|
$3,716.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.80 |
| Max. Negotiated Rate |
$3,567.36 |
| Rate for Payer: Aetna Commercial |
$2,861.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,898.48
|
| Rate for Payer: Cash Price |
$1,858.00
|
| Rate for Payer: Cigna Commercial |
$3,084.28
|
| Rate for Payer: First Health Commercial |
$3,530.20
|
| Rate for Payer: Humana Commercial |
$3,158.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,047.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,742.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,114.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,270.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,787.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,972.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.04
|
| Rate for Payer: PHCS Commercial |
$3,567.36
|
| Rate for Payer: United Healthcare All Payer |
$3,270.08
|
|
|
OSTIAL 10FR CANNULA BIO TRONIC
|
Facility
|
OP
|
$3,716.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.80 |
| Max. Negotiated Rate |
$3,567.36 |
| Rate for Payer: Aetna Commercial |
$2,861.32
|
| Rate for Payer: Anthem Medicaid |
$1,277.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,898.48
|
| Rate for Payer: Cash Price |
$1,858.00
|
| Rate for Payer: Cigna Commercial |
$3,084.28
|
| Rate for Payer: First Health Commercial |
$3,530.20
|
| Rate for Payer: Humana Commercial |
$3,158.60
|
| Rate for Payer: Humana KY Medicaid |
$1,277.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,290.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,047.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,742.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,114.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,303.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,270.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,787.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,972.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.04
|
| Rate for Payer: PHCS Commercial |
$3,567.36
|
| Rate for Payer: United Healthcare All Payer |
$3,270.08
|
|
|
OS TISS CULTUR CHROMSOM ANALY
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
30001462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.73 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$140.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$140.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$790.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$197.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$140.73
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Humana KY Medicaid |
$140.73
|
| Rate for Payer: Humana Medicare Advantage |
$140.73
|
| Rate for Payer: Kentucky WC Medicaid |
$142.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
OS TISS CULTUR CHROMSOM ANALY
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
30001462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$295.50 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$790.96
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
OS TISS TRANSGLUTAMIN AB IGG
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
30000385
|
|
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 TISS TRANSGLUTAMIN AB IGG
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
30000385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| 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 |
$11.53
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Kentucky WC Medicaid |
$11.65
|
| 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 |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| 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 TISSUE CULTURE AMNIOTIC FL
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
HCPCS 88235
|
| Hospital Charge Code |
30001463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.10 |
| Max. Negotiated Rate |
$409.92 |
| Rate for Payer: Aetna Commercial |
$328.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.88
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cigna Commercial |
$354.41
|
| Rate for Payer: First Health Commercial |
$405.65
|
| Rate for Payer: Humana Commercial |
$362.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$375.76
|
| Rate for Payer: Ohio Health Group HMO |
$320.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$371.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.63
|
| Rate for Payer: PHCS Commercial |
$409.92
|
| Rate for Payer: United Healthcare All Payer |
$375.76
|
|
|
OS TISSUE CULTURE AMNIOTIC FL
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
HCPCS 88235
|
| Hospital Charge Code |
30001463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.30 |
| Max. Negotiated Rate |
$409.92 |
| Rate for Payer: Aetna Commercial |
$328.79
|
| Rate for Payer: Anthem Medicaid |
$150.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$150.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$210.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.30
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cigna Commercial |
$354.41
|
| Rate for Payer: First Health Commercial |
$405.65
|
| Rate for Payer: Humana Commercial |
$362.95
|
| Rate for Payer: Humana KY Medicaid |
$150.30
|
| Rate for Payer: Humana Medicare Advantage |
$150.30
|
| Rate for Payer: Kentucky WC Medicaid |
$151.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$375.76
|
| Rate for Payer: Ohio Health Group HMO |
$320.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$371.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.63
|
| Rate for Payer: PHCS Commercial |
$409.92
|
| Rate for Payer: United Healthcare All Payer |
$375.76
|
|
|
OS TISSUE CULTURE LYMPHOCYTE
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
30001941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.30 |
| Max. Negotiated Rate |
$557.76 |
| Rate for Payer: Aetna Commercial |
$447.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$466.54
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cigna Commercial |
$482.23
|
| Rate for Payer: First Health Commercial |
$551.95
|
| Rate for Payer: Humana Commercial |
$493.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$476.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$511.28
|
| Rate for Payer: Ohio Health Group HMO |
$435.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$400.89
|
| Rate for Payer: PHCS Commercial |
$557.76
|
| Rate for Payer: United Healthcare All Payer |
$511.28
|
|
|
OS TISSUE CULTURE LYMPHOCYTE
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
30001941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$557.76 |
| Rate for Payer: Aetna Commercial |
$447.37
|
| Rate for Payer: Anthem Medicaid |
$116.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$116.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$466.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$163.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$116.49
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cigna Commercial |
$482.23
|
| Rate for Payer: First Health Commercial |
$551.95
|
| Rate for Payer: Humana Commercial |
$493.85
|
| Rate for Payer: Humana KY Medicaid |
$116.49
|
| Rate for Payer: Humana Medicare Advantage |
$116.49
|
| Rate for Payer: Kentucky WC Medicaid |
$117.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$476.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$511.28
|
| Rate for Payer: Ohio Health Group HMO |
$435.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$400.89
|
| Rate for Payer: PHCS Commercial |
$557.76
|
| Rate for Payer: United Healthcare All Payer |
$511.28
|
|
|
OS TISSUE CULTURE MAYO
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
30001465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.75 |
| Max. Negotiated Rate |
$752.64 |
| Rate for Payer: Aetna Commercial |
$603.68
|
| Rate for Payer: Anthem Medicaid |
$143.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$143.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$201.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.75
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna Commercial |
$650.72
|
| Rate for Payer: First Health Commercial |
$744.80
|
| Rate for Payer: Humana Commercial |
$666.40
|
| Rate for Payer: Humana KY Medicaid |
$143.75
|
| Rate for Payer: Humana Medicare Advantage |
$143.75
|
| Rate for Payer: Kentucky WC Medicaid |
$145.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.92
|
| Rate for Payer: Ohio Health Group HMO |
$588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$627.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.96
|
| Rate for Payer: PHCS Commercial |
$752.64
|
| Rate for Payer: United Healthcare All Payer |
$689.92
|
|
|
OS TISSUE CULTURE MAYO
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
30001465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$752.64 |
| Rate for Payer: Aetna Commercial |
$603.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.55
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna Commercial |
$650.72
|
| Rate for Payer: First Health Commercial |
$744.80
|
| Rate for Payer: Humana Commercial |
$666.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.92
|
| Rate for Payer: Ohio Health Group HMO |
$588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$627.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.96
|
| Rate for Payer: PHCS Commercial |
$752.64
|
| Rate for Payer: United Healthcare All Payer |
$689.92
|
|
|
OS TISSUE EXAM BY PATHOLOGIST
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
30001953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$239.04 |
| Rate for Payer: Aetna Commercial |
$191.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.95
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: First Health Commercial |
$236.55
|
| Rate for Payer: Humana Commercial |
$211.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$204.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$219.12
|
| Rate for Payer: Ohio Health Group HMO |
$186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$199.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$216.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.81
|
| Rate for Payer: PHCS Commercial |
$239.04
|
| Rate for Payer: United Healthcare All Payer |
$219.12
|
|
