|
OS TRICHOSPORON PULLULANS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000879
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS TRICHOSPORON PULLULANS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000879
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS TRICYCLIC ANTIDEPRESSANT MH
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS 80336
|
| Hospital Charge Code |
30000097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem Medicaid |
$7.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Humana KY Medicaid |
$7.57
|
| Rate for Payer: Kentucky WC Medicaid |
$7.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
OS TRICYCLIC ANTIDEPRESSANT MH
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS 80336
|
| Hospital Charge Code |
30000097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
OS TRICYCLIC ANTIDEPRESSANT MH
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
OS TRICYCLIC ANTIDEPRESSANT MH
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
OS TRICYCLIC ANTIDEP SCREEN S
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
HCPCS 80336
|
| Hospital Charge Code |
30000096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem Medicaid |
$119.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Humana KY Medicaid |
$119.68
|
| Rate for Payer: Kentucky WC Medicaid |
$120.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.12
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS TRICYCLIC ANTIDEP SCREEN S
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.12
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS TRICYCLIC ANTIDEP SCREEN S
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.12
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS TRICYCLIC ANTIDEP SCREEN S
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
HCPCS 80336
|
| Hospital Charge Code |
30000096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.44
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.12
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
OS TRIGLYCERIDES
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000540
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem Medicaid |
$5.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.74
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Humana KY Medicaid |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.74
|
| Rate for Payer: Kentucky WC Medicaid |
$5.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
OS TRIGLYCERIDES
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000540
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
OS TRYPTASE S
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| 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 |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.58
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
OS TRYPTASE S
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.58
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
OS TSH SENSITIVE S
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
30000531
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.57
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.10
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
OS TSH SENSITIVE S
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
30000531
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem Medicaid |
$16.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Humana KY Medicaid |
$16.80
|
| Rate for Payer: Humana Medicare Advantage |
$16.80
|
| Rate for Payer: Kentucky WC Medicaid |
$16.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.10
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
OS TUMOR IMMUNOHISTOCHEM/MANUA
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
30001994
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$391.68 |
| Rate for Payer: Aetna Commercial |
$314.16
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$338.64
|
| Rate for Payer: First Health Commercial |
$387.60
|
| Rate for Payer: Humana Commercial |
$346.80
|
| Rate for Payer: Humana KY Medicaid |
$158.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.33
|
| Rate for Payer: Kentucky WC Medicaid |
$159.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$334.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.04
|
| Rate for Payer: Ohio Health Group HMO |
$306.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.52
|
| Rate for Payer: PHCS Commercial |
$391.68
|
| Rate for Payer: United Healthcare All Payer |
$359.04
|
|
|
OS TUMOR IMMUNOHISTOCHEM/MANUA
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
30001994
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$391.68 |
| Rate for Payer: Aetna Commercial |
$314.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.62
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$338.64
|
| Rate for Payer: First Health Commercial |
$387.60
|
| Rate for Payer: Humana Commercial |
$346.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$334.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.04
|
| Rate for Payer: Ohio Health Group HMO |
$306.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.52
|
| Rate for Payer: PHCS Commercial |
$391.68
|
| Rate for Payer: United Healthcare All Payer |
$359.04
|
|
|
OS TUMOR MICROSATELLITE INSTAB
|
Facility
|
OP
|
$1,278.00
|
|
|
Service Code
|
HCPCS 81301
|
| Hospital Charge Code |
30001992
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$348.56 |
| Max. Negotiated Rate |
$1,226.88 |
| Rate for Payer: Aetna Commercial |
$984.06
|
| Rate for Payer: Anthem Medicaid |
$348.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$348.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,026.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$487.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$348.56
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna Commercial |
$1,060.74
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: Humana Commercial |
$1,086.30
|
| Rate for Payer: Humana KY Medicaid |
$348.56
|
| Rate for Payer: Humana Medicare Advantage |
$348.56
|
| Rate for Payer: Kentucky WC Medicaid |
$352.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$418.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$355.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,124.64
|
| Rate for Payer: Ohio Health Group HMO |
$958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$881.82
|
| Rate for Payer: PHCS Commercial |
$1,226.88
|
| Rate for Payer: United Healthcare All Payer |
$1,124.64
|
|
|
OS TUMOR MICROSATELLITE INSTAB
|
Facility
|
IP
|
$1,278.00
|
|
|
Service Code
|
HCPCS 81301
|
| Hospital Charge Code |
30001992
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$1,226.88 |
| Rate for Payer: Aetna Commercial |
$984.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,026.23
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna Commercial |
$1,060.74
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: Humana Commercial |
$1,086.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,124.64
|
| Rate for Payer: Ohio Health Group HMO |
$958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$881.82
|
| Rate for Payer: PHCS Commercial |
$1,226.88
|
| Rate for Payer: United Healthcare All Payer |
$1,124.64
|
|
|
OS TUNA IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000789
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS TUNA IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000789
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS TURKEY FEATHERS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000881
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS TURKEY FEATHERS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000881
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS TURKEY IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000755
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
