|
HEPATITIS B SURFACE AG CONF
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 87341
|
| Hospital Charge Code |
30001980
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$10.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.33
|
| Rate for Payer: Cash Price |
$46.50
|
| 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: Humana KY Medicaid |
$10.33
|
| Rate for Payer: Humana Medicare Advantage |
$10.33
|
| Rate for Payer: Kentucky WC Medicaid |
$10.43
|
| 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 |
$12.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.54
|
| 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
|
|
|
HEPATITIS B SURFACE ANTIGEN
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
30001350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem Medicaid |
$10.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.33
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Humana KY Medicaid |
$10.33
|
| Rate for Payer: Humana Medicare Advantage |
$10.33
|
| Rate for Payer: Kentucky WC Medicaid |
$10.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.31
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
HEPATITIS B SURFACE ANTIGEN
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
30001350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.13 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.31
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
30001789
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem Medicaid |
$14.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.27
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Humana KY Medicaid |
$14.27
|
| Rate for Payer: Humana Medicare Advantage |
$14.27
|
| Rate for Payer: Kentucky WC Medicaid |
$14.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.78
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
HEPATITIS C ANTIBODY
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
30001789
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$138.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$12.71
|
| Rate for Payer: Healthspan PPO |
$13.81
|
| Rate for Payer: Multiplan PHCS |
$82.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$96.60
|
| Rate for Payer: UHCCP Medicaid |
$48.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.56
|
|
|
HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
30001789
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.81
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.78
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
HEPATITIS CORE IGM ANTIBODY
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
30001183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
HEPATITIS CORE IGM ANTIBODY
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
30001183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$11.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.77
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Humana KY Medicaid |
$11.77
|
| Rate for Payer: Humana Medicare Advantage |
$11.77
|
| Rate for Payer: Kentucky WC Medicaid |
$11.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
HEPATOBILIARY
|
Facility
|
IP
|
$1,989.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
34000009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$258.57 |
| Max. Negotiated Rate |
$1,909.44 |
| Rate for Payer: Aetna Commercial |
$1,531.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.42
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cigna Commercial |
$1,650.87
|
| Rate for Payer: First Health Commercial |
$1,889.55
|
| Rate for Payer: Humana Commercial |
$1,690.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.59
|
| Rate for Payer: PHCS Commercial |
$1,909.44
|
| Rate for Payer: United Healthcare All Payer |
$1,750.32
|
|
|
HEPATOBILIARY
|
Professional
|
Both
|
$1,989.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
34000009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Anthem Medicaid |
$251.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,989.00
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cigna Commercial |
$535.55
|
| Rate for Payer: Healthspan PPO |
$356.05
|
| Rate for Payer: Humana Medicaid |
$251.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$256.36
|
| Rate for Payer: Molina Healthcare Passport |
$251.33
|
| Rate for Payer: Multiplan PHCS |
$1,193.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,392.30
|
| Rate for Payer: UHCCP Medicaid |
$696.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.84
|
|
|
HEPATOBILIARY
|
Facility
|
OP
|
$1,989.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
34000009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$258.57 |
| Max. Negotiated Rate |
$1,909.44 |
| Rate for Payer: Aetna Commercial |
$1,531.53
|
| Rate for Payer: Anthem Medicaid |
$684.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cigna Commercial |
$1,650.87
|
| Rate for Payer: First Health Commercial |
$1,889.55
|
| Rate for Payer: Humana Commercial |
$1,690.65
|
| Rate for Payer: Humana KY Medicaid |
$684.02
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$690.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.59
|
| Rate for Payer: PHCS Commercial |
$1,909.44
|
| Rate for Payer: United Healthcare All Payer |
$1,750.32
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
|
Facility
|
IP
|
$19,999.27
|
|
|
Service Code
|
MSDRG 421
|
| Min. Negotiated Rate |
$13,570.93 |
| Max. Negotiated Rate |
$19,999.27 |
| Rate for Payer: Anthem Medicaid |
$13,570.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,285.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19,999.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,285.01
|
| Rate for Payer: Humana KY Medicaid |
$13,570.93
|
| Rate for Payer: Humana Medicare Advantage |
$14,285.19
|
| Rate for Payer: Kentucky WC Medicaid |
$13,706.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,142.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,842.35
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$37,443.62
|
|
|
Service Code
|
MSDRG 420
|
| Min. Negotiated Rate |
$25,408.17 |
| Max. Negotiated Rate |
$37,443.62 |
| Rate for Payer: Anthem Medicaid |
$25,408.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26,745.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37,443.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$36,106.34
|
| Rate for Payer: Humana KY Medicaid |
$25,408.17
|
| Rate for Payer: Humana Medicare Advantage |
$26,745.44
|
| Rate for Payer: Kentucky WC Medicaid |
$25,662.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,094.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,916.33
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$16,506.18
|
|
|
Service Code
|
MSDRG 422
|
| Min. Negotiated Rate |
$11,200.62 |
| Max. Negotiated Rate |
$16,506.18 |
| Rate for Payer: Anthem Medicaid |
$11,200.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,790.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,506.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,916.68
|
| Rate for Payer: Humana KY Medicaid |
$11,200.62
|
| Rate for Payer: Humana Medicare Advantage |
$11,790.13
|
| Rate for Payer: Kentucky WC Medicaid |
$11,312.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,148.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,424.64
|
|
|
HEPATOBILIARY(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
340P0009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$535.55 |
| Rate for Payer: Anthem Medicaid |
$251.33
|
| 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: Cigna Commercial |
$535.55
|
| Rate for Payer: Healthspan PPO |
$356.05
|
| Rate for Payer: Humana Medicaid |
$251.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$256.36
|
| Rate for Payer: Molina Healthcare Passport |
$251.33
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.84
|
|
|
HEPATOBILIARY(T
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
340T0009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$242.32 |
| Max. Negotiated Rate |
$1,789.44 |
| Rate for Payer: Aetna Commercial |
$1,435.28
|
| Rate for Payer: Anthem Medicaid |
$641.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,453.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cigna Commercial |
$1,547.12
|
| Rate for Payer: First Health Commercial |
$1,770.80
|
| Rate for Payer: Humana Commercial |
$1,584.40
|
| Rate for Payer: Humana KY Medicaid |
$641.03
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$647.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,375.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$653.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$577.84
|
| Rate for Payer: PHCS Commercial |
$1,789.44
|
| Rate for Payer: United Healthcare All Payer |
$1,640.32
|
|
|
HEPATOBILIARY(T
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
340T0009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$242.32 |
| Max. Negotiated Rate |
$1,789.44 |
| Rate for Payer: Aetna Commercial |
$1,435.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,453.92
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cigna Commercial |
$1,547.12
|
| Rate for Payer: First Health Commercial |
$1,770.80
|
| Rate for Payer: Humana Commercial |
$1,584.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,375.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$577.84
|
| Rate for Payer: PHCS Commercial |
$1,789.44
|
| Rate for Payer: United Healthcare All Payer |
$1,640.32
|
|
|
HEPATOBIL SYST IMAGE W/DRUG
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
34000010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$467.40 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem Medicaid |
$1,306.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Humana KY Medicaid |
$1,306.82
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,320.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,333.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
HEPATOBIL SYST IMAGE W/DRUG
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
34000010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$47.41 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Anthem Medicaid |
$343.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,800.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$732.68
|
| Rate for Payer: Healthspan PPO |
$483.97
|
| Rate for Payer: Humana Medicaid |
$343.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.65
|
| Rate for Payer: Molina Healthcare Passport |
$343.77
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,660.00
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$347.21
|
|
|
HEPATOBIL SYST IMAGE W/DRUG
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
34000010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
HEPATOBIL SYST IMAGE W/DRUG(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
340P0010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$732.68 |
| Rate for Payer: Anthem Medicaid |
$343.77
|
| 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: Cigna Commercial |
$732.68
|
| Rate for Payer: Healthspan PPO |
$483.97
|
| Rate for Payer: Humana Medicaid |
$343.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.65
|
| Rate for Payer: Molina Healthcare Passport |
$343.77
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$347.21
|
|
|
HEPATOBIL SYST IMAGE W/DRUG(T
|
Facility
|
OP
|
$3,675.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
340T0010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$467.40 |
| Max. Negotiated Rate |
$3,528.00 |
| Rate for Payer: Aetna Commercial |
$2,829.75
|
| Rate for Payer: Anthem Medicaid |
$1,263.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,866.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: Cigna Commercial |
$3,050.25
|
| Rate for Payer: First Health Commercial |
$3,491.25
|
| Rate for Payer: Humana Commercial |
$3,123.75
|
| Rate for Payer: Humana KY Medicaid |
$1,263.83
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,276.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,013.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,712.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,289.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,234.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,756.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$735.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,139.25
|
| Rate for Payer: PHCS Commercial |
$3,528.00
|
| Rate for Payer: United Healthcare All Payer |
$3,234.00
|
|
|
HEPATOBIL SYST IMAGE W/DRUG(T
|
Facility
|
IP
|
$3,675.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
340T0010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$3,528.00 |
| Rate for Payer: Aetna Commercial |
$2,829.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,866.50
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: Cigna Commercial |
$3,050.25
|
| Rate for Payer: First Health Commercial |
$3,491.25
|
| Rate for Payer: Humana Commercial |
$3,123.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,013.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,712.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,234.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,756.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$735.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,139.25
|
| Rate for Payer: PHCS Commercial |
$3,528.00
|
| Rate for Payer: United Healthcare All Payer |
$3,234.00
|
|
|
HEP A VACCINE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
77000010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$255.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.23
|
| Rate for Payer: Multiplan PHCS |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.50
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
|
|
HEP A VACCINE
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
77000010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$198.90
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.05
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
