|
HEPARIN(GEN)1000U(10,000/10)
|
Facility
|
IP
|
$114.27
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$109.70 |
| Rate for Payer: Aetna Commercial |
$87.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.13
|
| Rate for Payer: Cash Price |
$57.13
|
| Rate for Payer: Cigna Commercial |
$94.84
|
| Rate for Payer: First Health Commercial |
$108.56
|
| Rate for Payer: Humana Commercial |
$97.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.56
|
| Rate for Payer: Ohio Health Group HMO |
$85.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.42
|
| Rate for Payer: PHCS Commercial |
$109.70
|
| Rate for Payer: United Healthcare All Payer |
$100.56
|
|
|
HEPARIN(GEN)1000U(10,000/10)
|
Facility
|
OP
|
$114.27
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$109.70 |
| Rate for Payer: Aetna Commercial |
$87.99
|
| Rate for Payer: Anthem Medicaid |
$39.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.13
|
| Rate for Payer: Cash Price |
$57.13
|
| Rate for Payer: Cigna Commercial |
$94.84
|
| Rate for Payer: First Health Commercial |
$108.56
|
| Rate for Payer: Humana Commercial |
$97.13
|
| Rate for Payer: Humana KY Medicaid |
$39.30
|
| Rate for Payer: Kentucky WC Medicaid |
$39.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.56
|
| Rate for Payer: Ohio Health Group HMO |
$85.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.42
|
| Rate for Payer: PHCS Commercial |
$109.70
|
| Rate for Payer: United Healthcare All Payer |
$100.56
|
|
|
HEPARIN LOCK FLUSH 10 100U/1ML
|
Facility
|
IP
|
$77.61
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
25002127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$74.51 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.54
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cigna Commercial |
$64.42
|
| Rate for Payer: First Health Commercial |
$73.73
|
| Rate for Payer: Humana Commercial |
$65.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.30
|
| Rate for Payer: Ohio Health Group HMO |
$58.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.06
|
| Rate for Payer: PHCS Commercial |
$74.51
|
| Rate for Payer: United Healthcare All Payer |
$68.30
|
|
|
HEPARIN LOCK FLUSH 10 100U/1ML
|
Facility
|
OP
|
$77.61
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
25002127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$74.51 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Anthem Medicaid |
$26.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.54
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cigna Commercial |
$64.42
|
| Rate for Payer: First Health Commercial |
$73.73
|
| Rate for Payer: Humana Commercial |
$65.97
|
| Rate for Payer: Humana KY Medicaid |
$26.69
|
| Rate for Payer: Kentucky WC Medicaid |
$26.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.30
|
| Rate for Payer: Ohio Health Group HMO |
$58.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.06
|
| Rate for Payer: PHCS Commercial |
$74.51
|
| Rate for Payer: United Healthcare All Payer |
$68.30
|
|
|
HEPARIN SOD 1000U 50000U/5ML V
|
Facility
|
IP
|
$181.67
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$174.40 |
| Rate for Payer: Aetna Commercial |
$139.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Cash Price |
$90.83
|
| Rate for Payer: Cigna Commercial |
$150.79
|
| Rate for Payer: First Health Commercial |
$172.59
|
| Rate for Payer: Humana Commercial |
$154.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.87
|
| Rate for Payer: Ohio Health Group HMO |
$136.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.32
|
| Rate for Payer: PHCS Commercial |
$174.40
|
| Rate for Payer: United Healthcare All Payer |
$159.87
|
|
|
HEPARIN SOD 1000U 50000U/5ML V
|
Facility
|
OP
|
$181.67
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$174.40 |
| Rate for Payer: Aetna Commercial |
$139.89
|
| Rate for Payer: Anthem Medicaid |
$62.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Cash Price |
$90.83
|
| Rate for Payer: Cigna Commercial |
$150.79
|
| Rate for Payer: First Health Commercial |
$172.59
|
| Rate for Payer: Humana Commercial |
$154.42
|
| Rate for Payer: Humana KY Medicaid |
$62.48
|
| Rate for Payer: Kentucky WC Medicaid |
$63.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.87
|
| Rate for Payer: Ohio Health Group HMO |
$136.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.32
|
| Rate for Payer: PHCS Commercial |
$174.40
|
| Rate for Payer: United Healthcare All Payer |
$159.87
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
OP
|
$75.02
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
636T0035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.02 |
| Rate for Payer: Aetna Commercial |
$57.77
|
| Rate for Payer: Anthem Medicaid |
$25.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.52
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cigna Commercial |
$62.27
|
| Rate for Payer: First Health Commercial |
$71.27
|
| Rate for Payer: Humana Commercial |
$63.77
|
| Rate for Payer: Humana KY Medicaid |
$25.80
|
| Rate for Payer: Kentucky WC Medicaid |
$26.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.02
|
| Rate for Payer: Ohio Health Group HMO |
$56.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.26
|
| Rate for Payer: PHCS Commercial |
$72.02
|
| Rate for Payer: United Healthcare All Payer |
$66.02
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Professional
|
Both
|
$75.02
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$75.02 |
| Rate for Payer: Aetna Commercial |
$0.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.02
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.38
|
| Rate for Payer: Multiplan PHCS |
$45.01
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.51
|
| Rate for Payer: UHCCP Medicaid |
$26.26
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
OP
|
$75.02
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.02 |
| Rate for Payer: Aetna Commercial |
$57.77
|
| Rate for Payer: Anthem Medicaid |
$25.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.52
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cigna Commercial |
$62.27
|
| Rate for Payer: First Health Commercial |
$71.27
|
| Rate for Payer: Humana Commercial |
$63.77
|
| Rate for Payer: Humana KY Medicaid |
$25.80
|
| Rate for Payer: Kentucky WC Medicaid |
$26.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.02
|
| Rate for Payer: Ohio Health Group HMO |
$56.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.26
|
| Rate for Payer: PHCS Commercial |
$72.02
|
| Rate for Payer: United Healthcare All Payer |
$66.02
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
OP
|
$77.50
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$74.40 |
| Rate for Payer: Aetna Commercial |
$59.68
|
| Rate for Payer: Anthem Medicaid |
$26.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.45
|
| Rate for Payer: Cash Price |
$38.75
|
| Rate for Payer: Cigna Commercial |
$64.32
|
| Rate for Payer: First Health Commercial |
$73.62
|
| Rate for Payer: Humana Commercial |
$65.88
|
| Rate for Payer: Humana KY Medicaid |
$26.65
|
| Rate for Payer: Kentucky WC Medicaid |
$26.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.20
|
| Rate for Payer: Ohio Health Group HMO |
$58.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.02
|
| Rate for Payer: PHCS Commercial |
$74.40
|
| Rate for Payer: United Healthcare All Payer |
$68.20
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
IP
|
$75.02
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
636T0035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.02 |
| Rate for Payer: Aetna Commercial |
$57.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.52
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cigna Commercial |
$62.27
|
| Rate for Payer: First Health Commercial |
$71.27
|
| Rate for Payer: Humana Commercial |
$63.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.02
|
| Rate for Payer: Ohio Health Group HMO |
$56.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.26
|
| Rate for Payer: PHCS Commercial |
$72.02
|
| Rate for Payer: United Healthcare All Payer |
$66.02
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
IP
|
$75.02
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.02 |
| Rate for Payer: Aetna Commercial |
$57.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.52
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cigna Commercial |
$62.27
|
| Rate for Payer: First Health Commercial |
$71.27
|
| Rate for Payer: Humana Commercial |
$63.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.02
|
| Rate for Payer: Ohio Health Group HMO |
$56.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.26
|
| Rate for Payer: PHCS Commercial |
$72.02
|
| Rate for Payer: United Healthcare All Payer |
$66.02
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
IP
|
$77.50
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$74.40 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.20
|
| Rate for Payer: Ohio Health Group HMO |
$58.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.02
|
| Rate for Payer: PHCS Commercial |
$74.40
|
| Rate for Payer: United Healthcare All Payer |
$68.20
|
| Rate for Payer: Aetna Commercial |
$59.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.45
|
| Rate for Payer: Cash Price |
$38.75
|
| Rate for Payer: Cigna Commercial |
$64.32
|
| Rate for Payer: First Health Commercial |
$73.62
|
| Rate for Payer: Humana Commercial |
$65.88
|
|
|
HEPARSOD 1000U 5000U/ML 10MLVL
|
Facility
|
IP
|
$124.39
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$119.41 |
| Rate for Payer: Aetna Commercial |
$95.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.02
|
| Rate for Payer: Cash Price |
$62.20
|
| Rate for Payer: Cigna Commercial |
$103.24
|
| Rate for Payer: First Health Commercial |
$118.17
|
| Rate for Payer: Humana Commercial |
$105.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.46
|
| Rate for Payer: Ohio Health Group HMO |
$93.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.56
|
| Rate for Payer: PHCS Commercial |
$119.41
|
| Rate for Payer: United Healthcare All Payer |
$109.46
|
|
|
HEPARSOD 1000U 5000U/ML 10MLVL
|
Facility
|
OP
|
$124.39
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$119.41 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.02
|
| Rate for Payer: Cash Price |
$62.20
|
| Rate for Payer: Cigna Commercial |
$103.24
|
| Rate for Payer: First Health Commercial |
$118.17
|
| Rate for Payer: Humana Commercial |
$105.73
|
| Rate for Payer: Humana KY Medicaid |
$42.78
|
| Rate for Payer: Kentucky WC Medicaid |
$43.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.46
|
| Rate for Payer: Ohio Health Group HMO |
$93.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.56
|
| Rate for Payer: PHCS Commercial |
$119.41
|
| Rate for Payer: United Healthcare All Payer |
$109.46
|
| Rate for Payer: Aetna Commercial |
$95.78
|
| Rate for Payer: Anthem Medicaid |
$42.78
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47120
|
| Hospital Charge Code |
76101949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$968.70 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$3,365.98
|
| Rate for Payer: Anthem Medicaid |
$968.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,600.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$3,145.71
|
| Rate for Payer: Healthspan PPO |
$2,838.59
|
| Rate for Payer: Humana Medicaid |
$968.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,971.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$988.07
|
| Rate for Payer: Molina Healthcare Passport |
$968.70
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,520.00
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$978.39
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Professional
|
Both
|
$4,750.00
|
|
|
Service Code
|
HCPCS 47130
|
| Hospital Charge Code |
76101950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,535.32 |
| Max. Negotiated Rate |
$4,838.51 |
| Rate for Payer: Aetna Commercial |
$4,838.51
|
| Rate for Payer: Anthem Medicaid |
$1,535.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,750.00
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cigna Commercial |
$4,540.47
|
| Rate for Payer: Healthspan PPO |
$4,080.40
|
| Rate for Payer: Humana Medicaid |
$1,535.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,228.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,566.03
|
| Rate for Payer: Molina Healthcare Passport |
$1,535.32
|
| Rate for Payer: Multiplan PHCS |
$2,850.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,325.00
|
| Rate for Payer: UHCCP Medicaid |
$1,662.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,550.67
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
HCPCS 47130
|
| Hospital Charge Code |
76101950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.50 |
| Max. Negotiated Rate |
$4,560.00 |
| Rate for Payer: Aetna Commercial |
$3,657.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,705.00
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cigna Commercial |
$3,942.50
|
| Rate for Payer: First Health Commercial |
$4,512.50
|
| Rate for Payer: Humana Commercial |
$4,037.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,895.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,180.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.50
|
| Rate for Payer: PHCS Commercial |
$4,560.00
|
| Rate for Payer: United Healthcare All Payer |
$4,180.00
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47120
|
| Hospital Charge Code |
76101949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
HCPCS 47130
|
| Hospital Charge Code |
76101950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.50 |
| Max. Negotiated Rate |
$4,560.00 |
| Rate for Payer: Aetna Commercial |
$3,657.50
|
| Rate for Payer: Anthem Medicaid |
$1,633.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,705.00
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cigna Commercial |
$3,942.50
|
| Rate for Payer: First Health Commercial |
$4,512.50
|
| Rate for Payer: Humana Commercial |
$4,037.50
|
| Rate for Payer: Humana KY Medicaid |
$1,633.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,895.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,425.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,180.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.50
|
| Rate for Payer: PHCS Commercial |
$4,560.00
|
| Rate for Payer: United Healthcare All Payer |
$4,180.00
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47120
|
| Hospital Charge Code |
76101949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
HEPATECTOMY - RESECTION OF L(P
|
Professional
|
Both
|
$4,750.00
|
|
|
Service Code
|
HCPCS 47130
|
| Hospital Charge Code |
761P1950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,535.32 |
| Max. Negotiated Rate |
$4,838.51 |
| Rate for Payer: Aetna Commercial |
$4,838.51
|
| Rate for Payer: Anthem Medicaid |
$1,535.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,750.00
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cigna Commercial |
$4,540.47
|
| Rate for Payer: Healthspan PPO |
$4,080.40
|
| Rate for Payer: Humana Medicaid |
$1,535.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,228.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,566.03
|
| Rate for Payer: Molina Healthcare Passport |
$1,535.32
|
| Rate for Payer: Multiplan PHCS |
$2,850.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,325.00
|
| Rate for Payer: UHCCP Medicaid |
$1,662.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,550.67
|
|
|
HEPATECTOMY - RESECTION OF L(P
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47120
|
| Hospital Charge Code |
761P1949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$968.70 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$3,365.98
|
| Rate for Payer: Anthem Medicaid |
$968.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,600.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$3,145.71
|
| Rate for Payer: Healthspan PPO |
$2,838.59
|
| Rate for Payer: Humana Medicaid |
$968.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,971.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$988.07
|
| Rate for Payer: Molina Healthcare Passport |
$968.70
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,520.00
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$978.39
|
|
|
HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
30000014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$105.60 |
| Rate for Payer: Aetna Commercial |
$84.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.33
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$91.30
|
| Rate for Payer: First Health Commercial |
$104.50
|
| Rate for Payer: Humana Commercial |
$93.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.80
|
| Rate for Payer: Ohio Health Group HMO |
$82.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.10
|
| Rate for Payer: PHCS Commercial |
$105.60
|
| Rate for Payer: United Healthcare All Payer |
$96.80
|
|
|
HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
30000014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$105.60 |
| Rate for Payer: Aetna Commercial |
$84.70
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$91.30
|
| Rate for Payer: First Health Commercial |
$104.50
|
| Rate for Payer: Humana Commercial |
$93.50
|
| Rate for Payer: Humana KY Medicaid |
$8.17
|
| Rate for Payer: Humana Medicare Advantage |
$8.17
|
| Rate for Payer: Kentucky WC Medicaid |
$8.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.80
|
| Rate for Payer: Ohio Health Group HMO |
$82.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.10
|
| Rate for Payer: PHCS Commercial |
$105.60
|
| Rate for Payer: United Healthcare All Payer |
$96.80
|
|
