|
HEP A 3 DOSE SCHEDULE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 90634
|
| Hospital Charge Code |
77000012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$15.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$15.48
|
| Rate for Payer: Kentucky WC Medicaid |
$15.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
HEP A 3 DOSE SCHEDULE
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 90634
|
| Hospital Charge Code |
77000012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$58.84 |
| Rate for Payer: Anthem Medicaid |
$29.55
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Healthspan PPO |
$14.80
|
| Rate for Payer: Humana Medicaid |
$29.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$58.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.14
|
| Rate for Payer: Molina Healthcare Passport |
$29.55
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.85
|
|
|
HEP A 3 DOSE SCHEDULE(T
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 90634
|
| Hospital Charge Code |
770T0012
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$15.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$15.48
|
| Rate for Payer: Kentucky WC Medicaid |
$15.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
HEP A 3 DOSE SCHEDULE(T
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 90634
|
| Hospital Charge Code |
770T0012
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
HEP A/B VAC
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
77000013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem Medicaid |
$126.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Humana KY Medicaid |
$126.56
|
| Rate for Payer: Kentucky WC Medicaid |
$127.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.92
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
HEP A/B VAC
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
77000013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: Anthem Medicaid |
$112.35
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Healthspan PPO |
$97.92
|
| Rate for Payer: Humana Medicaid |
$112.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$184.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.60
|
| Rate for Payer: Molina Healthcare Passport |
$112.35
|
| Rate for Payer: Multiplan PHCS |
$220.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.60
|
| Rate for Payer: UHCCP Medicaid |
$128.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.47
|
|
|
HEP A/B VAC
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
77000013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.92
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
HEP A/B VAC(T
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
770T0013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem Medicaid |
$126.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Humana KY Medicaid |
$126.56
|
| Rate for Payer: Kentucky WC Medicaid |
$127.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.92
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
HEP A/B VAC(T
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
770T0013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.92
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
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 |
$34.38 |
| 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 |
$91.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.07
|
| Rate for Payer: PHCS Commercial |
$110.02
|
| Rate for Payer: United Healthcare All Payer |
$100.85
|
|
|
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 |
$34.38 |
| 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 |
$91.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.07
|
| Rate for Payer: PHCS Commercial |
$110.02
|
| Rate for Payer: United Healthcare All Payer |
$100.85
|
|
|
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 |
$5.38 |
| 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 |
$14.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.37
|
| Rate for Payer: PHCS Commercial |
$17.21
|
| Rate for Payer: United Healthcare All Payer |
$15.78
|
|
|
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 |
$5.38 |
| 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 |
$14.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.37
|
| Rate for Payer: PHCS Commercial |
$17.21
|
| Rate for Payer: United Healthcare All Payer |
$15.78
|
|
|
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 |
$32.72 |
| 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 |
$85.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.25
|
| 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 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 |
$32.72 |
| 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 |
$85.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.70
|
| 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 1000 UNITS SDV
|
Facility
|
OP
|
$9.81
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| 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 |
$7.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.77
|
| Rate for Payer: PHCS Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Payer |
$8.63
|
|
|
HEPARIN 1000 UNITS SDV
|
Facility
|
IP
|
$9.81
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| 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 |
$7.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.77
|
| Rate for Payer: PHCS Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Payer |
$8.63
|
|
|
HEPARIN 10UN[500UNIT/5ML]FLUSH
|
Facility
|
IP
|
$63.83
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
25002125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.15 |
| 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 |
$51.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.04
|
| Rate for Payer: PHCS Commercial |
$61.28
|
| Rate for Payer: United Healthcare All Payer |
$56.17
|
|
|
HEPARIN 10UN[500UNIT/5ML]FLUSH
|
Facility
|
OP
|
$63.83
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
25002125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.15 |
| 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 |
$51.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.04
|
| Rate for Payer: PHCS Commercial |
$61.28
|
| Rate for Payer: United Healthcare All Payer |
$56.17
|
|
|
HEPARIN 12500 U/250ML IV SOL
|
Facility
|
IP
|
$120.54
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25003098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$115.72 |
| Rate for Payer: Aetna Commercial |
$92.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.02
|
| Rate for Payer: Cash Price |
$60.27
|
| Rate for Payer: Cigna Commercial |
$100.05
|
| Rate for Payer: First Health Commercial |
$114.51
|
| Rate for Payer: Humana Commercial |
$102.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.08
|
| Rate for Payer: Ohio Health Group HMO |
$90.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.17
|
| Rate for Payer: PHCS Commercial |
$115.72
|
| Rate for Payer: United Healthcare All Payer |
$106.08
|
|
|
HEPARIN 12500 U/250ML IV SOL
|
Facility
|
OP
|
$120.54
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25003098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$115.72 |
| Rate for Payer: Aetna Commercial |
$92.82
|
| Rate for Payer: Anthem Medicaid |
$41.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.02
|
| Rate for Payer: Cash Price |
$60.27
|
| Rate for Payer: Cigna Commercial |
$100.05
|
| Rate for Payer: First Health Commercial |
$114.51
|
| Rate for Payer: Humana Commercial |
$102.46
|
| Rate for Payer: Humana KY Medicaid |
$41.45
|
| Rate for Payer: Kentucky WC Medicaid |
$41.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.08
|
| Rate for Payer: Ohio Health Group HMO |
$90.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.17
|
| Rate for Payer: PHCS Commercial |
$115.72
|
| Rate for Payer: United Healthcare All Payer |
$106.08
|
|
|
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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 Medicare Advantage/PPO |
$13.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.67
|
| Rate for Payer: Humana Medicare Advantage |
$13.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.71
|
|
|
HEPARIN/D5W 1000 UNITS (25000)
|
Facility
|
OP
|
$123.42
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25003100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.03 |
| Max. Negotiated Rate |
$118.48 |
| Rate for Payer: Aetna Commercial |
$95.03
|
| Rate for Payer: Anthem Medicaid |
$42.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.27
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cigna Commercial |
$102.44
|
| Rate for Payer: First Health Commercial |
$117.25
|
| Rate for Payer: Humana Commercial |
$104.91
|
| Rate for Payer: Humana KY Medicaid |
$42.44
|
| Rate for Payer: Kentucky WC Medicaid |
$42.88
|
| 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 |
$37.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.61
|
| Rate for Payer: Ohio Health Group HMO |
$92.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.16
|
| Rate for Payer: PHCS Commercial |
$118.48
|
| Rate for Payer: United Healthcare All Payer |
$108.61
|
|
