|
OS TISSUE EXAM BY PATHOLOGIST
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
30001953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$239.04 |
| Rate for Payer: Aetna Commercial |
$191.73
|
| Rate for Payer: Anthem Medicaid |
$49.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$69.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.37
|
| Rate for Payer: Cash Price |
$124.50
|
| 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: Humana KY Medicaid |
$49.37
|
| Rate for Payer: Humana Medicare Advantage |
$49.37
|
| Rate for Payer: Kentucky WC Medicaid |
$49.86
|
| 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 |
$59.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.36
|
| 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
|
|
|
OS TISSUE TRANSGLUT AB IGA S
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
30000379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.54
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS TISSUE TRANSGLUT AB IGA S
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
30000379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Aetna Commercial |
$127.82
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: First Health Commercial |
$157.70
|
| Rate for Payer: Humana Commercial |
$141.10
|
| 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 |
$136.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.08
|
| Rate for Payer: Ohio Health Group HMO |
$124.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.54
|
| Rate for Payer: PHCS Commercial |
$159.36
|
| Rate for Payer: United Healthcare All Payer |
$146.08
|
|
|
OS TISSUE TRANS IGA
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
30000400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| 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 |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.57
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
OS TISSUE TRANS IGA
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
30000400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.57
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
OS TOMATO IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000680
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
OS TOMATO IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000680
|
|
Hospital Revenue Code
|
302
|
| 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 TOPIRMATE SERUM
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 80201
|
| Hospital Charge Code |
30000051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.42
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
OS TOPIRMATE SERUM
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 80201
|
| Hospital Charge Code |
30000051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$11.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.92
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$11.92
|
| Rate for Payer: Humana Medicare Advantage |
$11.92
|
| Rate for Payer: Kentucky WC Medicaid |
$12.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
OS TOTAL ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
30000472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Humana KY Medicaid |
$5.18
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
OS TOTAL ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
30000472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
OS TOTAL TAU
|
Facility
|
OP
|
$749.30
|
|
|
Service Code
|
HCPCS 84394
|
| Hospital Charge Code |
30002081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$224.79 |
| Max. Negotiated Rate |
$719.33 |
| Rate for Payer: Aetna Commercial |
$576.96
|
| Rate for Payer: Anthem Medicaid |
$257.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$601.69
|
| Rate for Payer: Cash Price |
$374.65
|
| Rate for Payer: Cigna Commercial |
$621.92
|
| Rate for Payer: First Health Commercial |
$711.84
|
| Rate for Payer: Humana Commercial |
$636.90
|
| Rate for Payer: Humana KY Medicaid |
$257.68
|
| Rate for Payer: Kentucky WC Medicaid |
$260.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$614.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$659.38
|
| Rate for Payer: Ohio Health Group HMO |
$561.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$599.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.02
|
| Rate for Payer: PHCS Commercial |
$719.33
|
| Rate for Payer: United Healthcare All Payer |
$659.38
|
|
|
OS TOTAL TAU
|
Facility
|
IP
|
$749.30
|
|
|
Service Code
|
HCPCS 84394
|
| Hospital Charge Code |
30002081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$224.79 |
| Max. Negotiated Rate |
$719.33 |
| Rate for Payer: Aetna Commercial |
$576.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$601.69
|
| Rate for Payer: Cash Price |
$374.65
|
| Rate for Payer: Cigna Commercial |
$621.92
|
| Rate for Payer: First Health Commercial |
$711.84
|
| Rate for Payer: Humana Commercial |
$636.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$614.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$659.38
|
| Rate for Payer: Ohio Health Group HMO |
$561.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$599.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.02
|
| Rate for Payer: PHCS Commercial |
$719.33
|
| Rate for Payer: United Healthcare All Payer |
$659.38
|
|
|
OS TOXASSURE 13
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
30001777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.48
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
OS TOXASSURE 13
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
30001777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.59 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem Medicaid |
$156.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$156.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$219.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$156.59
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Humana KY Medicaid |
$156.59
|
| Rate for Payer: Humana Medicare Advantage |
$156.59
|
| Rate for Payer: Kentucky WC Medicaid |
$158.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
OS TOXOCARA CANIS ANTIBODY S
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
30001163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$239.29
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.62
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
OS TOXOCARA CANIS ANTIBODY S
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
30001163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem Medicaid |
$13.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$239.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.01
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Humana KY Medicaid |
$13.01
|
| Rate for Payer: Humana Medicare Advantage |
$13.01
|
| Rate for Payer: Kentucky WC Medicaid |
$13.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.62
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
OS TOXOPLASMA AB IGM S
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
30001215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
OS TOXOPLASMA AB IGM S
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
30001215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$14.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.41
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$14.41
|
| Rate for Payer: Humana Medicare Advantage |
$14.41
|
| Rate for Payer: Kentucky WC Medicaid |
$14.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
OS TOXOPLASM GONDII BY PCR CSF
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001394
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
OS TOXOPLASM GONDII BY PCR CSF
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001394
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.68
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
OS TP53 GENE TRGT SEQUENCE ALY
|
Facility
|
OP
|
$918.00
|
|
|
Service Code
|
HCPCS 81352
|
| Hospital Charge Code |
30001908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$329.51 |
| Max. Negotiated Rate |
$881.28 |
| Rate for Payer: Aetna Commercial |
$706.86
|
| Rate for Payer: Anthem Medicaid |
$329.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$329.51
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cigna Commercial |
$761.94
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Humana Commercial |
$780.30
|
| Rate for Payer: Humana KY Medicaid |
$329.51
|
| Rate for Payer: Humana Medicare Advantage |
$329.51
|
| Rate for Payer: Kentucky WC Medicaid |
$332.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$752.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$677.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$336.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$807.84
|
| Rate for Payer: Ohio Health Group HMO |
$688.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$734.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$798.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$633.42
|
| Rate for Payer: PHCS Commercial |
$881.28
|
| Rate for Payer: United Healthcare All Payer |
$807.84
|
|
|
OS TP53 GENE TRGT SEQUENCE ALY
|
Facility
|
IP
|
$918.00
|
|
|
Service Code
|
HCPCS 81352
|
| Hospital Charge Code |
30001908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$881.28 |
| Rate for Payer: Aetna Commercial |
$706.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.15
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cigna Commercial |
$761.94
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Humana Commercial |
$780.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$752.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$677.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$275.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$807.84
|
| Rate for Payer: Ohio Health Group HMO |
$688.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$734.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$798.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$633.42
|
| Rate for Payer: PHCS Commercial |
$881.28
|
| Rate for Payer: United Healthcare All Payer |
$807.84
|
|
|
OS TPO ANTIBODIES
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
OS TPO ANTIBODIES
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$14.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| 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 |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
