|
HEPATIC FUNCTION PANEL
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
30000014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$7.19
|
| Rate for Payer: Healthspan PPO |
$6.62
|
| Rate for Payer: Multiplan PHCS |
$66.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$77.00
|
| Rate for Payer: UHCCP Medicaid |
$38.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.90
|
|
|
HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (82247) BILIRUBIN, DIRECT (82248) PHOSPHATASE, ALKALINE (84075) PROTEIN, TOTAL (84155) TRANSFERASE, ALANINE AMINO (ALT) (SGPT) (84460) TRANSFERASE, ASPARTATE AMINO (AST) (SGOT) (84450)
|
Facility
|
OP
|
$11.44
|
|
|
Service Code
|
CPT 80076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$11.44 |
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.17
|
| 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: Molina Healthcare Benefit Exchange |
$9.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.33
|
|
|
HEPATIC VISCERAL ARTERIOGRAM
|
Facility
|
IP
|
$7,900.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32000385
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,027.00 |
| Max. Negotiated Rate |
$7,584.00 |
| Rate for Payer: Aetna Commercial |
$6,083.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,162.00
|
| Rate for Payer: Cash Price |
$3,950.00
|
| Rate for Payer: Cigna Commercial |
$6,557.00
|
| Rate for Payer: First Health Commercial |
$7,505.00
|
| Rate for Payer: Humana Commercial |
$6,715.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,830.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,370.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,952.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,027.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,449.00
|
| Rate for Payer: PHCS Commercial |
$7,584.00
|
| Rate for Payer: United Healthcare All Payer |
$6,952.00
|
|
|
HEPATIC VISCERAL ARTERIOGRAM
|
Facility
|
OP
|
$7,900.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32000385
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,027.00 |
| Max. Negotiated Rate |
$7,584.00 |
| Rate for Payer: Aetna Commercial |
$6,083.00
|
| Rate for Payer: Anthem Medicaid |
$2,716.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,162.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$3,950.00
|
| Rate for Payer: Cash Price |
$3,950.00
|
| Rate for Payer: Cigna Commercial |
$6,557.00
|
| Rate for Payer: First Health Commercial |
$7,505.00
|
| Rate for Payer: Humana Commercial |
$6,715.00
|
| Rate for Payer: Humana KY Medicaid |
$2,716.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,744.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,830.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,771.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,952.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,027.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,449.00
|
| Rate for Payer: PHCS Commercial |
$7,584.00
|
| Rate for Payer: United Healthcare All Payer |
$6,952.00
|
|
|
HEPATITIS A AB (IGM)
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
30001187
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
HEPATITIS A AB (IGM)
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
30001187
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$11.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.26
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Humana KY Medicaid |
$11.26
|
| Rate for Payer: Humana Medicare Advantage |
$11.26
|
| Rate for Payer: Kentucky WC Medicaid |
$11.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
HEPATITIS A AB TOTAL
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
30001186
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
HEPATITIS A AB TOTAL
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
30001186
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$12.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.39
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Humana KY Medicaid |
$12.39
|
| Rate for Payer: Humana Medicare Advantage |
$12.39
|
| Rate for Payer: Kentucky WC Medicaid |
$12.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
HEPATITIS BC AB TOTAL
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
30001182
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
HEPATITIS BC AB TOTAL
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
30001182
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
HEPATITIS B INJ 20 YRS +
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
77000052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.34
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
|
|
HEPATITIS B INJ 20 YRS +
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
77000052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
HEPATITIS B INJ 20 YRS +
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
77000052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
HEPATITIS B INJ 20 YRS +(T
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
770T0052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Aetna Commercial |
$260.06
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem Medicaid |
$116.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.44
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Cigna Commercial |
$280.32
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$320.85
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana Commercial |
$287.08
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Humana KY Medicaid |
$116.15
|
| Rate for Payer: Kentucky WC Medicaid |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.21
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group HMO |
$253.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.70
|
| Rate for Payer: PHCS Commercial |
$324.23
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$297.21
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
HEPATITIS B INJ 20 YRS +(T
|
Facility
|
OP
|
$337.74
|
|
|
Service Code
|
HCPCS 90746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.91 |
| Max. Negotiated Rate |
$324.23 |
| Rate for Payer: Aetna Commercial |
$260.06
|
| Rate for Payer: Anthem Medicaid |
$116.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.44
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Cigna Commercial |
$280.32
|
| Rate for Payer: First Health Commercial |
$320.85
|
| Rate for Payer: Humana Commercial |
$287.08
|
| Rate for Payer: Humana KY Medicaid |
$116.15
|
| Rate for Payer: Kentucky WC Medicaid |
$117.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.21
|
| Rate for Payer: Ohio Health Group HMO |
$253.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.70
|
| Rate for Payer: PHCS Commercial |
$324.23
|
| Rate for Payer: United Healthcare All Payer |
$297.21
|
|
|
HEPATITIS B INJ 20 YRS +(T
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
770T0052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Aetna Commercial |
$260.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.44
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: Cigna Commercial |
$280.32
|
| Rate for Payer: First Health Commercial |
$320.85
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$287.08
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.21
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group HMO |
$253.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: PHCS Commercial |
$324.23
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
| Rate for Payer: United Healthcare All Payer |
$297.21
|
|
|
HEPATITIS B INJ 20 YRS +(T
|
Facility
|
IP
|
$337.74
|
|
|
Service Code
|
HCPCS 90746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.91 |
| Max. Negotiated Rate |
$324.23 |
| Rate for Payer: Aetna Commercial |
$260.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.44
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Cigna Commercial |
$280.32
|
| Rate for Payer: First Health Commercial |
$320.85
|
| Rate for Payer: Humana Commercial |
$287.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.21
|
| Rate for Payer: Ohio Health Group HMO |
$253.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.70
|
| Rate for Payer: PHCS Commercial |
$324.23
|
| Rate for Payer: United Healthcare All Payer |
$297.21
|
|
|
HEPATITIS B INJ NEWBORN-11YR
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
77000051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
HEPATITIS B INJ NEWBORN-11YR
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
77000051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$56.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$56.06
|
| Rate for Payer: Kentucky WC Medicaid |
$56.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
HEPATITIS B INJ NEWBORN-11YR
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
77000051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.89 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$163.00
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Healthspan PPO |
$32.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.88
|
| Rate for Payer: Multiplan PHCS |
$97.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.10
|
| Rate for Payer: UHCCP Medicaid |
$57.05
|
|
|
HEPATITIS B INJ NEWBORN-11YR(T
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
770T0051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
HEPATITIS B INJ NEWBORN-11YR(T
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
770T0051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$56.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$56.06
|
| Rate for Payer: Kentucky WC Medicaid |
$56.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
HEPATITIS BS AB ANTIBODY
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
30001184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
HEPATITIS BS AB ANTIBODY
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
30001184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$10.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.74
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Humana KY Medicaid |
$10.74
|
| Rate for Payer: Humana Medicare Advantage |
$10.74
|
| Rate for Payer: Kentucky WC Medicaid |
$10.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
HEPATITIS B SURFACE AG CONF
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 87341
|
| Hospital Charge Code |
30001980
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
