|
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP;
|
Facility
|
OP
|
$3,399.27
|
|
|
Service Code
|
CPT 46255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,428.05 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
|
|
HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S)
|
Facility
|
OP
|
$1,106.49
|
|
|
Service Code
|
CPT 46221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$790.35 |
| Max. Negotiated Rate |
$1,106.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
|
|
HEMORRHOIDECTOMY SIMPLE
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 46255
|
| Hospital Charge Code |
76101920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
HEMORRHOIDECTOMY SIMPLE
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 46255
|
| Hospital Charge Code |
76101920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.04 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$486.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$287.04
|
| Rate for Payer: Anthem Medicaid |
$292.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$451.98
|
| Rate for Payer: Healthspan PPO |
$552.69
|
| Rate for Payer: Humana Medicaid |
$292.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$437.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$298.35
|
| Rate for Payer: Molina Healthcare Passport |
$292.50
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$301.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.42
|
|
|
HEMORRHOIDECTOMY SIMPLE
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 46255
|
| Hospital Charge Code |
76101920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem Medicaid |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Humana KY Medicaid |
$361.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$364.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
HEMORRHOIDECTOMY SIMPLE(P
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 46255
|
| Hospital Charge Code |
761P1920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.04 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$486.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$287.04
|
| Rate for Payer: Anthem Medicaid |
$292.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$451.98
|
| Rate for Payer: Healthspan PPO |
$552.69
|
| Rate for Payer: Humana Medicaid |
$292.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$437.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$298.35
|
| Rate for Payer: Molina Healthcare Passport |
$292.50
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$301.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.42
|
|
|
HEMORRHOID STAPLE PROC.
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 46947
|
| Hospital Charge Code |
76101943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.70 |
| Max. Negotiated Rate |
$534.10 |
| Rate for Payer: Aetna Commercial |
$534.10
|
| Rate for Payer: Anthem Medicaid |
$242.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$482.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$489.11
|
| Rate for Payer: Healthspan PPO |
$450.41
|
| Rate for Payer: Humana Medicaid |
$242.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$475.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.72
|
| Rate for Payer: Molina Healthcare Passport |
$242.86
|
| Rate for Payer: Multiplan PHCS |
$289.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$337.40
|
| Rate for Payer: UHCCP Medicaid |
$168.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.29
|
|
|
HEMORRHOID STAPLE PROC.
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
HCPCS 46947
|
| Hospital Charge Code |
76101943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem Medicaid |
$165.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Humana KY Medicaid |
$165.76
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$167.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.42
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
|
|
HEMORRHOID STAPLE PROC.
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
HCPCS 46947
|
| Hospital Charge Code |
76101943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$462.72 |
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.42
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
|
|
HEMORRHOID STAPLE PROC.(P
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 46947
|
| Hospital Charge Code |
761P1943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.70 |
| Max. Negotiated Rate |
$534.10 |
| Rate for Payer: Aetna Commercial |
$534.10
|
| Rate for Payer: Anthem Medicaid |
$242.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$482.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$489.11
|
| Rate for Payer: Healthspan PPO |
$450.41
|
| Rate for Payer: Humana Medicaid |
$242.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$475.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.72
|
| Rate for Payer: Molina Healthcare Passport |
$242.86
|
| Rate for Payer: Multiplan PHCS |
$289.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$337.40
|
| Rate for Payer: UHCCP Medicaid |
$168.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.29
|
|
|
HEMRDECTMY COMPLIC INTERNAL
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 46946
|
| Hospital Charge Code |
76101942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
HEMRDECTMY COMPLIC INTERNAL
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 46946
|
| Hospital Charge Code |
76101942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
HEMRDECTMY COMPLIC INTERNAL
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 46946
|
| Hospital Charge Code |
76101942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.12 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$307.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$198.12
|
| Rate for Payer: Anthem Medicaid |
$295.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$371.28
|
| Rate for Payer: Healthspan PPO |
$339.58
|
| Rate for Payer: Humana Medicaid |
$295.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$275.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.27
|
| Rate for Payer: Molina Healthcare Passport |
$295.36
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$208.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.31
|
|
|
HEMRDECTMY COMPLIC INTERNAL(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 46946
|
| Hospital Charge Code |
761P1942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.12 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: UHCCP Medicaid |
$208.03
|
| Rate for Payer: Aetna Commercial |
$307.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$198.12
|
| Rate for Payer: Anthem Medicaid |
$295.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$371.28
|
| Rate for Payer: Healthspan PPO |
$339.58
|
| Rate for Payer: Humana Medicaid |
$295.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$275.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.27
|
| Rate for Payer: Molina Healthcare Passport |
$295.36
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.31
|
|
|
HEP A 2 DOSE SCHEDULE
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
77000011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Healthspan PPO |
$35.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$58.84
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
|
|
HEP A 2 DOSE SCHEDULE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
77000011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem Medicaid |
$42.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Humana KY Medicaid |
$42.99
|
| Rate for Payer: Kentucky WC Medicaid |
$43.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
HEP A 2 DOSE SCHEDULE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
77000011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
HEP A 2 DOSE SCHEDULE(T
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
770T0011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem Medicaid |
$42.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Humana KY Medicaid |
$42.99
|
| Rate for Payer: Kentucky WC Medicaid |
$43.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
HEP A 2 DOSE SCHEDULE(T
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
770T0011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
HEP A 3 DOSE SCHEDULE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 90634
|
| Hospital Charge Code |
77000012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.95
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
HEP A 3 DOSE SCHEDULE
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 90634
|
| Hospital Charge Code |
77000012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$58.84 |
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Healthspan PPO |
$14.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$58.84
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
|
|
HEP A 3 DOSE SCHEDULE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 90634
|
| Hospital Charge Code |
77000012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$15.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$15.48
|
| Rate for Payer: Kentucky WC Medicaid |
$15.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.95
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
HEP A 3 DOSE SCHEDULE(T
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 90634
|
| Hospital Charge Code |
770T0012
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$15.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$15.48
|
| Rate for Payer: Kentucky WC Medicaid |
$15.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.95
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
HEP A 3 DOSE SCHEDULE(T
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 90634
|
| Hospital Charge Code |
770T0012
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.95
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
HEP A/B VAC
|
Facility
|
IP
|
$367.10
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
77000013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$352.42 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Cash Price |
$183.55
|
| Rate for Payer: Cigna Commercial |
$304.69
|
| Rate for Payer: First Health Commercial |
$348.74
|
| Rate for Payer: Humana Commercial |
$312.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.05
|
| Rate for Payer: Ohio Health Group HMO |
$275.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.80
|
| Rate for Payer: PHCS Commercial |
$352.42
|
| Rate for Payer: United Healthcare All Payer |
$323.05
|
|
