HEP A/B VAC
|
Facility
|
OP
|
$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 Medicaid |
$126.25
|
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: Humana KY Medicaid |
$126.25
|
Rate for Payer: Kentucky WC Medicaid |
$127.53
|
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: Molina Healthcare Medicaid |
$128.78
|
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
|
|
HEP A/B VAC
|
Professional
|
Both
|
$367.10
|
|
Service Code
|
HCPCS 90636
|
Hospital Charge Code |
77000013
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$97.92 |
Max. Negotiated Rate |
$367.10 |
Rate for Payer: Buckeye Medicare Advantage |
$367.10
|
Rate for Payer: Cash Price |
$183.55
|
Rate for Payer: Cash Price |
$183.55
|
Rate for Payer: Healthspan PPO |
$97.92
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$184.34
|
Rate for Payer: Multiplan PHCS |
$220.26
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$256.97
|
Rate for Payer: UHCCP Medicaid |
$128.48
|
|
HEP A/B VAC(T
|
Facility
|
IP
|
$367.10
|
|
Service Code
|
HCPCS 90636
|
Hospital Charge Code |
770T0013
|
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
|
|
HEP A/B VAC(T
|
Facility
|
OP
|
$367.10
|
|
Service Code
|
HCPCS 90636
|
Hospital Charge Code |
770T0013
|
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 Medicaid |
$126.25
|
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: Humana KY Medicaid |
$126.25
|
Rate for Payer: Kentucky WC Medicaid |
$127.53
|
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: Molina Healthcare Medicaid |
$128.78
|
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
|
|
HEPARIN 10000 UNIT/ML VL (4ML)
|
Facility
|
OP
|
$114.60
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25002135
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$14.90 |
Max. Negotiated Rate |
$110.02 |
Rate for Payer: Aetna Commercial |
$88.24
|
Rate for Payer: Anthem Medicaid |
$39.41
|
Rate for Payer: Anthem POS/PPO/Traditional |
$89.39
|
Rate for Payer: Cash Price |
$57.30
|
Rate for Payer: Cigna Commercial |
$95.12
|
Rate for Payer: First Health Commercial |
$108.87
|
Rate for Payer: Humana Commercial |
$97.41
|
Rate for Payer: Humana KY Medicaid |
$39.41
|
Rate for Payer: Kentucky WC Medicaid |
$39.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$93.97
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.57
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$34.38
|
Rate for Payer: Molina Healthcare Medicaid |
$40.20
|
Rate for Payer: Ohio Health Choice Commercial |
$100.85
|
Rate for Payer: Ohio Health Group HMO |
$85.95
|
Rate for Payer: Ohio Health Group PPO Differential |
$22.92
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.53
|
Rate for Payer: PHCS Commercial |
$110.02
|
Rate for Payer: United Healthcare All Payer |
$100.85
|
|
HEPARIN 10000 UNIT/ML VL (4ML)
|
Facility
|
IP
|
$114.60
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25002135
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$14.90 |
Max. Negotiated Rate |
$110.02 |
Rate for Payer: Aetna Commercial |
$88.24
|
Rate for Payer: Anthem POS/PPO/Traditional |
$89.39
|
Rate for Payer: Cash Price |
$57.30
|
Rate for Payer: Cigna Commercial |
$95.12
|
Rate for Payer: First Health Commercial |
$108.87
|
Rate for Payer: Humana Commercial |
$97.41
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$93.97
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.57
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$34.38
|
Rate for Payer: Ohio Health Choice Commercial |
$100.85
|
Rate for Payer: Ohio Health Group HMO |
$85.95
|
Rate for Payer: Ohio Health Group PPO Differential |
$22.92
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.53
|
Rate for Payer: PHCS Commercial |
$110.02
|
Rate for Payer: United Healthcare All Payer |
$100.85
|
|
HEPARIN 1000 U(10,000 U/10mL)
|
Facility
|
IP
|
$109.27
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25002136
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$14.21 |
Max. Negotiated Rate |
$104.90 |
Rate for Payer: Aetna Commercial |
$84.14
|
Rate for Payer: Anthem POS/PPO/Traditional |
$85.23
|
Rate for Payer: Cash Price |
$54.63
|
Rate for Payer: Cigna Commercial |
$90.69
|
Rate for Payer: First Health Commercial |
$103.81
|
Rate for Payer: Humana Commercial |
$92.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$89.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$32.78
|
Rate for Payer: Ohio Health Choice Commercial |
$96.16
|
Rate for Payer: Ohio Health Group HMO |
$81.95
|
Rate for Payer: Ohio Health Group PPO Differential |
$21.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.87
|
Rate for Payer: PHCS Commercial |
$104.90
|
Rate for Payer: United Healthcare All Payer |
$96.16
|
|
HEPARIN 1000 U(10,000 U/10mL)
|
Facility
|
OP
|
$109.27
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25002136
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$14.21 |
Max. Negotiated Rate |
$104.90 |
Rate for Payer: Aetna Commercial |
$84.14
|
Rate for Payer: Anthem Medicaid |
$37.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$85.23
|
Rate for Payer: Cash Price |
$54.63
|
Rate for Payer: Cigna Commercial |
$90.69
|
Rate for Payer: First Health Commercial |
$103.81
|
Rate for Payer: Humana Commercial |
$92.88
|
Rate for Payer: Humana KY Medicaid |
$37.58
|
Rate for Payer: Kentucky WC Medicaid |
$37.96
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$89.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$32.78
|
Rate for Payer: Molina Healthcare Medicaid |
$38.33
|
Rate for Payer: Ohio Health Choice Commercial |
$96.16
|
Rate for Payer: Ohio Health Group HMO |
$81.95
|
Rate for Payer: Ohio Health Group PPO Differential |
$21.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.87
|
Rate for Payer: PHCS Commercial |
$104.90
|
Rate for Payer: United Healthcare All Payer |
$96.16
|
|
HEPARIN 1000 U(10,000 U/1mL)
|
Facility
|
IP
|
$17.93
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25002131
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.33 |
Max. Negotiated Rate |
$17.21 |
Rate for Payer: Aetna Commercial |
$13.81
|
Rate for Payer: Anthem POS/PPO/Traditional |
$13.99
|
Rate for Payer: Cash Price |
$8.96
|
Rate for Payer: Cigna Commercial |
$14.88
|
Rate for Payer: First Health Commercial |
$17.03
|
Rate for Payer: Humana Commercial |
$15.24
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$14.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.23
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$5.38
|
Rate for Payer: Ohio Health Choice Commercial |
$15.78
|
Rate for Payer: Ohio Health Group HMO |
$13.45
|
Rate for Payer: Ohio Health Group PPO Differential |
$3.59
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.33
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.56
|
Rate for Payer: PHCS Commercial |
$17.21
|
Rate for Payer: United Healthcare All Payer |
$15.78
|
|
HEPARIN 1000 U(10,000 U/1mL)
|
Facility
|
OP
|
$17.93
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25002131
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.33 |
Max. Negotiated Rate |
$17.21 |
Rate for Payer: Aetna Commercial |
$13.81
|
Rate for Payer: Anthem Medicaid |
$6.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$13.99
|
Rate for Payer: Cash Price |
$8.96
|
Rate for Payer: Cigna Commercial |
$14.88
|
Rate for Payer: First Health Commercial |
$17.03
|
Rate for Payer: Humana Commercial |
$15.24
|
Rate for Payer: Humana KY Medicaid |
$6.17
|
Rate for Payer: Kentucky WC Medicaid |
$6.23
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$14.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.23
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$5.38
|
Rate for Payer: Molina Healthcare Medicaid |
$6.29
|
Rate for Payer: Ohio Health Choice Commercial |
$15.78
|
Rate for Payer: Ohio Health Group HMO |
$13.45
|
Rate for Payer: Ohio Health Group PPO Differential |
$3.59
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.33
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.56
|
Rate for Payer: PHCS Commercial |
$17.21
|
Rate for Payer: United Healthcare All Payer |
$15.78
|
|
HEPARIN 1000U(2000 U/0.9%) NAC
|
Facility
|
OP
|
$109.06
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25003099
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$14.18 |
Max. Negotiated Rate |
$104.70 |
Rate for Payer: Aetna Commercial |
$83.98
|
Rate for Payer: Aetna Commercial |
$87.83
|
Rate for Payer: Anthem Medicaid |
$37.51
|
Rate for Payer: Anthem Medicaid |
$39.23
|
Rate for Payer: Anthem POS/PPO/Traditional |
$85.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$88.97
|
Rate for Payer: Cash Price |
$54.53
|
Rate for Payer: Cash Price |
$57.03
|
Rate for Payer: Cigna Commercial |
$94.67
|
Rate for Payer: Cigna Commercial |
$90.52
|
Rate for Payer: First Health Commercial |
$108.36
|
Rate for Payer: First Health Commercial |
$103.61
|
Rate for Payer: Humana Commercial |
$92.70
|
Rate for Payer: Humana Commercial |
$96.95
|
Rate for Payer: Humana KY Medicaid |
$37.51
|
Rate for Payer: Humana KY Medicaid |
$39.23
|
Rate for Payer: Kentucky WC Medicaid |
$39.62
|
Rate for Payer: Kentucky WC Medicaid |
$37.89
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$89.43
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$93.53
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.18
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.49
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$34.22
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$32.72
|
Rate for Payer: Molina Healthcare Medicaid |
$38.26
|
Rate for Payer: Molina Healthcare Medicaid |
$40.01
|
Rate for Payer: Ohio Health Choice Commercial |
$95.97
|
Rate for Payer: Ohio Health Choice Commercial |
$100.37
|
Rate for Payer: Ohio Health Group HMO |
$81.80
|
Rate for Payer: Ohio Health Group HMO |
$85.54
|
Rate for Payer: Ohio Health Group PPO Differential |
$21.81
|
Rate for Payer: Ohio Health Group PPO Differential |
$22.81
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.18
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.83
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.36
|
Rate for Payer: PHCS Commercial |
$109.50
|
Rate for Payer: PHCS Commercial |
$104.70
|
Rate for Payer: United Healthcare All Payer |
$100.37
|
Rate for Payer: United Healthcare All Payer |
$95.97
|
|
HEPARIN 1000U(2000 U/0.9%) NAC
|
Facility
|
IP
|
$109.06
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25003099
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$14.18 |
Max. Negotiated Rate |
$104.70 |
Rate for Payer: Aetna Commercial |
$83.98
|
Rate for Payer: Aetna Commercial |
$87.83
|
Rate for Payer: Anthem POS/PPO/Traditional |
$85.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$88.97
|
Rate for Payer: Cash Price |
$54.53
|
Rate for Payer: Cash Price |
$57.03
|
Rate for Payer: Cigna Commercial |
$90.52
|
Rate for Payer: Cigna Commercial |
$94.67
|
Rate for Payer: First Health Commercial |
$108.36
|
Rate for Payer: First Health Commercial |
$103.61
|
Rate for Payer: Humana Commercial |
$96.95
|
Rate for Payer: Humana Commercial |
$92.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$89.43
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$93.53
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.49
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.18
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$34.22
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$32.72
|
Rate for Payer: Ohio Health Choice Commercial |
$95.97
|
Rate for Payer: Ohio Health Choice Commercial |
$100.37
|
Rate for Payer: Ohio Health Group HMO |
$81.80
|
Rate for Payer: Ohio Health Group HMO |
$85.54
|
Rate for Payer: Ohio Health Group PPO Differential |
$21.81
|
Rate for Payer: Ohio Health Group PPO Differential |
$22.81
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.18
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.83
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.36
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
Rate for Payer: PHCS Commercial |
$104.70
|
Rate for Payer: PHCS Commercial |
$109.50
|
Rate for Payer: United Healthcare All Payer |
$95.97
|
Rate for Payer: United Healthcare All Payer |
$100.37
|
|
HEPARIN 1000 UNITS SDV
|
Facility
|
IP
|
$9.81
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25002134
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.28 |
Max. Negotiated Rate |
$9.42 |
Rate for Payer: Aetna Commercial |
$7.55
|
Rate for Payer: Anthem POS/PPO/Traditional |
$7.65
|
Rate for Payer: Cash Price |
$4.90
|
Rate for Payer: Cigna Commercial |
$8.14
|
Rate for Payer: First Health Commercial |
$9.32
|
Rate for Payer: Humana Commercial |
$8.34
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$8.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.24
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2.94
|
Rate for Payer: Ohio Health Choice Commercial |
$8.63
|
Rate for Payer: Ohio Health Group HMO |
$7.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
Rate for Payer: PHCS Commercial |
$9.42
|
Rate for Payer: United Healthcare All Payer |
$8.63
|
|
HEPARIN 1000 UNITS SDV
|
Facility
|
OP
|
$9.81
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25002134
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.28 |
Max. Negotiated Rate |
$9.42 |
Rate for Payer: Aetna Commercial |
$7.55
|
Rate for Payer: Anthem Medicaid |
$3.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$7.65
|
Rate for Payer: Cash Price |
$4.90
|
Rate for Payer: Cigna Commercial |
$8.14
|
Rate for Payer: First Health Commercial |
$9.32
|
Rate for Payer: Humana Commercial |
$8.34
|
Rate for Payer: Humana KY Medicaid |
$3.37
|
Rate for Payer: Kentucky WC Medicaid |
$3.41
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$8.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.24
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3.44
|
Rate for Payer: Ohio Health Choice Commercial |
$8.63
|
Rate for Payer: Ohio Health Group HMO |
$7.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
Rate for Payer: PHCS Commercial |
$9.42
|
Rate for Payer: United Healthcare All Payer |
$8.63
|
|
HEPARIN 10UN[500UNIT/5ML]FLUSH
|
Facility
|
OP
|
$63.83
|
|
Service Code
|
HCPCS J1642
|
Hospital Charge Code |
25002125
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8.30 |
Max. Negotiated Rate |
$61.28 |
Rate for Payer: Aetna Commercial |
$49.15
|
Rate for Payer: Anthem Medicaid |
$21.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$49.79
|
Rate for Payer: Cash Price |
$31.91
|
Rate for Payer: Cigna Commercial |
$52.98
|
Rate for Payer: First Health Commercial |
$60.64
|
Rate for Payer: Humana Commercial |
$54.26
|
Rate for Payer: Humana KY Medicaid |
$21.95
|
Rate for Payer: Kentucky WC Medicaid |
$22.17
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$52.34
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$19.15
|
Rate for Payer: Molina Healthcare Medicaid |
$22.39
|
Rate for Payer: Ohio Health Choice Commercial |
$56.17
|
Rate for Payer: Ohio Health Group HMO |
$47.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$12.77
|
Rate for Payer: Ohio Health Group PPO No Differential |
$8.30
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.79
|
Rate for Payer: PHCS Commercial |
$61.28
|
Rate for Payer: United Healthcare All Payer |
$56.17
|
|
HEPARIN 10UN[500UNIT/5ML]FLUSH
|
Facility
|
IP
|
$63.83
|
|
Service Code
|
HCPCS J1642
|
Hospital Charge Code |
25002125
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8.30 |
Max. Negotiated Rate |
$61.28 |
Rate for Payer: Aetna Commercial |
$49.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$49.79
|
Rate for Payer: Cash Price |
$31.91
|
Rate for Payer: Cigna Commercial |
$52.98
|
Rate for Payer: First Health Commercial |
$60.64
|
Rate for Payer: Humana Commercial |
$54.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$52.34
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$19.15
|
Rate for Payer: Ohio Health Choice Commercial |
$56.17
|
Rate for Payer: Ohio Health Group HMO |
$47.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$12.77
|
Rate for Payer: Ohio Health Group PPO No Differential |
$8.30
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.79
|
Rate for Payer: PHCS Commercial |
$61.28
|
Rate for Payer: United Healthcare All Payer |
$56.17
|
|
HEPARIN 12500 U/250ML IV SOL
|
Facility
|
IP
|
$119.31
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25003098
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$15.51 |
Max. Negotiated Rate |
$114.54 |
Rate for Payer: Aetna Commercial |
$91.87
|
Rate for Payer: Anthem POS/PPO/Traditional |
$93.06
|
Rate for Payer: Cash Price |
$59.66
|
Rate for Payer: Cigna Commercial |
$99.03
|
Rate for Payer: First Health Commercial |
$113.34
|
Rate for Payer: Humana Commercial |
$101.41
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$97.83
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.05
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$35.79
|
Rate for Payer: Ohio Health Choice Commercial |
$104.99
|
Rate for Payer: Ohio Health Group HMO |
$89.48
|
Rate for Payer: Ohio Health Group PPO Differential |
$23.86
|
Rate for Payer: Ohio Health Group PPO No Differential |
$15.51
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.99
|
Rate for Payer: PHCS Commercial |
$114.54
|
Rate for Payer: United Healthcare All Payer |
$104.99
|
|
HEPARIN 12500 U/250ML IV SOL
|
Facility
|
OP
|
$119.31
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25003098
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$15.51 |
Max. Negotiated Rate |
$114.54 |
Rate for Payer: Aetna Commercial |
$91.87
|
Rate for Payer: Anthem Medicaid |
$41.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$93.06
|
Rate for Payer: Cash Price |
$59.66
|
Rate for Payer: Cigna Commercial |
$99.03
|
Rate for Payer: First Health Commercial |
$113.34
|
Rate for Payer: Humana Commercial |
$101.41
|
Rate for Payer: Humana KY Medicaid |
$41.03
|
Rate for Payer: Kentucky WC Medicaid |
$41.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$97.83
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.05
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$35.79
|
Rate for Payer: Molina Healthcare Medicaid |
$41.85
|
Rate for Payer: Ohio Health Choice Commercial |
$104.99
|
Rate for Payer: Ohio Health Group HMO |
$89.48
|
Rate for Payer: Ohio Health Group PPO Differential |
$23.86
|
Rate for Payer: Ohio Health Group PPO No Differential |
$15.51
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.99
|
Rate for Payer: PHCS Commercial |
$114.54
|
Rate for Payer: United Healthcare All Payer |
$104.99
|
|
HEPARIN 2000U IN 0.9 NS 1000ML
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25003099
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
HEPARIN 2000U IN 0.9 NS 1000ML
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25003099
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
HEPARIN ASSAY
|
Facility
|
OP
|
$18.33
|
|
Service Code
|
CPT 85520
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$13.09 |
Max. Negotiated Rate |
$18.33 |
Rate for Payer: Anthem Medicaid |
$13.09
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$13.09
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.33
|
Rate for Payer: CareSource Just4Me Medicare |
$13.09
|
Rate for Payer: Humana KY Medicaid |
$13.09
|
Rate for Payer: Humana Medicare Advantage |
$13.09
|
Rate for Payer: Kentucky WC Medicaid |
$13.22
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$15.71
|
Rate for Payer: Molina Healthcare Medicaid |
$13.35
|
|
HEPARIN/D5W 1000 UNITS (25000)
|
Facility
|
OP
|
$123.41
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25003100
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$16.04 |
Max. Negotiated Rate |
$118.47 |
Rate for Payer: Aetna Commercial |
$95.03
|
Rate for Payer: Anthem Medicaid |
$42.44
|
Rate for Payer: Anthem POS/PPO/Traditional |
$96.26
|
Rate for Payer: Cash Price |
$61.70
|
Rate for Payer: Cigna Commercial |
$102.43
|
Rate for Payer: First Health Commercial |
$117.24
|
Rate for Payer: Humana Commercial |
$104.90
|
Rate for Payer: Humana KY Medicaid |
$42.44
|
Rate for Payer: Kentucky WC Medicaid |
$42.87
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$101.20
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$37.02
|
Rate for Payer: Molina Healthcare Medicaid |
$43.29
|
Rate for Payer: Ohio Health Choice Commercial |
$108.60
|
Rate for Payer: Ohio Health Group HMO |
$92.56
|
Rate for Payer: Ohio Health Group PPO Differential |
$24.68
|
Rate for Payer: Ohio Health Group PPO No Differential |
$16.04
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.26
|
Rate for Payer: PHCS Commercial |
$118.47
|
Rate for Payer: United Healthcare All Payer |
$108.60
|
|
HEPARIN/D5W 1000 UNITS (25000)
|
Facility
|
IP
|
$123.41
|
|
Service Code
|
HCPCS J1644
|
Hospital Charge Code |
25003100
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$16.04 |
Max. Negotiated Rate |
$118.47 |
Rate for Payer: Aetna Commercial |
$95.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$96.26
|
Rate for Payer: Cash Price |
$61.70
|
Rate for Payer: Cigna Commercial |
$102.43
|
Rate for Payer: First Health Commercial |
$117.24
|
Rate for Payer: Humana Commercial |
$104.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$101.20
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$37.02
|
Rate for Payer: Ohio Health Choice Commercial |
$108.60
|
Rate for Payer: Ohio Health Group HMO |
$92.56
|
Rate for Payer: Ohio Health Group PPO Differential |
$24.68
|
Rate for Payer: Ohio Health Group PPO No Differential |
$16.04
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.26
|
Rate for Payer: PHCS Commercial |
$118.47
|
Rate for Payer: United Healthcare All Payer |
$108.60
|
|
HEPARIN FLUSH 10 U/ML SYR(5mL)
|
Facility
|
OP
|
$77.00
|
|
Service Code
|
HCPCS J1642
|
Hospital Charge Code |
25003750
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$10.01 |
Max. Negotiated Rate |
$73.92 |
Rate for Payer: Aetna Commercial |
$59.29
|
Rate for Payer: Anthem Medicaid |
$26.48
|
Rate for Payer: Anthem POS/PPO/Traditional |
$60.06
|
Rate for Payer: Cash Price |
$38.50
|
Rate for Payer: Cigna Commercial |
$63.91
|
Rate for Payer: First Health Commercial |
$73.15
|
Rate for Payer: Humana Commercial |
$65.45
|
Rate for Payer: Humana KY Medicaid |
$26.48
|
Rate for Payer: Kentucky WC Medicaid |
$26.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
Rate for Payer: Molina Healthcare Medicaid |
$27.01
|
Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
Rate for Payer: Ohio Health Group HMO |
$57.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
Rate for Payer: PHCS Commercial |
$73.92
|
Rate for Payer: United Healthcare All Payer |
$67.76
|
|
HEPARIN FLUSH 10 U/ML SYR(5mL)
|
Facility
|
IP
|
$77.00
|
|
Service Code
|
HCPCS J1642
|
Hospital Charge Code |
25003750
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$10.01 |
Max. Negotiated Rate |
$73.92 |
Rate for Payer: Aetna Commercial |
$59.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$60.06
|
Rate for Payer: Cash Price |
$38.50
|
Rate for Payer: Cigna Commercial |
$63.91
|
Rate for Payer: First Health Commercial |
$73.15
|
Rate for Payer: Humana Commercial |
$65.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
Rate for Payer: Ohio Health Group HMO |
$57.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
Rate for Payer: PHCS Commercial |
$73.92
|
Rate for Payer: United Healthcare All Payer |
$67.76
|
|