|
HEPARIN/D5W 1000 UNITS (25000)
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
HEPARIN FLUSH 10 U/ML SYR(5mL)
|
Facility
|
OP
|
$63.60
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
25003750
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$61.06 |
| Rate for Payer: Aetna Commercial |
$48.97
|
| Rate for Payer: Anthem Medicaid |
$21.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.61
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$52.79
|
| Rate for Payer: First Health Commercial |
$60.42
|
| Rate for Payer: Humana Commercial |
$54.06
|
| Rate for Payer: Humana KY Medicaid |
$21.87
|
| Rate for Payer: Kentucky WC Medicaid |
$22.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.97
|
| Rate for Payer: Ohio Health Group HMO |
$47.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.88
|
| Rate for Payer: PHCS Commercial |
$61.06
|
| Rate for Payer: United Healthcare All Payer |
$55.97
|
|
|
HEPARIN FLUSH 10 U/ML SYR(5mL)
|
Facility
|
IP
|
$63.60
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
25003750
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$61.06 |
| Rate for Payer: Aetna Commercial |
$48.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.61
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$52.79
|
| Rate for Payer: First Health Commercial |
$60.42
|
| Rate for Payer: Humana Commercial |
$54.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.97
|
| Rate for Payer: Ohio Health Group HMO |
$47.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.88
|
| Rate for Payer: PHCS Commercial |
$61.06
|
| Rate for Payer: United Healthcare All Payer |
$55.97
|
|
|
HEPARIN(GEN)1000U(10,000/10)
|
Facility
|
IP
|
$109.27
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$104.90 |
| Rate for Payer: Aetna Commercial |
$84.14
|
| Rate for Payer: Aetna Commercial |
$87.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.13
|
| Rate for Payer: Cash Price |
$54.63
|
| Rate for Payer: Cash Price |
$57.13
|
| Rate for Payer: Cigna Commercial |
$90.69
|
| Rate for Payer: Cigna Commercial |
$94.84
|
| Rate for Payer: First Health Commercial |
$108.56
|
| Rate for Payer: First Health Commercial |
$103.81
|
| Rate for Payer: Humana Commercial |
$97.13
|
| Rate for Payer: Humana Commercial |
$92.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.56
|
| Rate for Payer: Ohio Health Group HMO |
$81.95
|
| Rate for Payer: Ohio Health Group HMO |
$85.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.40
|
| Rate for Payer: PHCS Commercial |
$104.90
|
| Rate for Payer: PHCS Commercial |
$109.70
|
| Rate for Payer: United Healthcare All Payer |
$96.16
|
| Rate for Payer: United Healthcare All Payer |
$100.56
|
|
|
HEPARIN(GEN)1000U(10,000/10)
|
Facility
|
OP
|
$109.27
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$104.90 |
| Rate for Payer: Aetna Commercial |
$84.14
|
| Rate for Payer: Aetna Commercial |
$87.99
|
| Rate for Payer: Anthem Medicaid |
$37.58
|
| Rate for Payer: Anthem Medicaid |
$39.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.13
|
| Rate for Payer: Cash Price |
$54.63
|
| Rate for Payer: Cash Price |
$57.13
|
| Rate for Payer: Cigna Commercial |
$94.84
|
| Rate for Payer: Cigna Commercial |
$90.69
|
| Rate for Payer: First Health Commercial |
$108.56
|
| Rate for Payer: First Health Commercial |
$103.81
|
| Rate for Payer: Humana Commercial |
$92.88
|
| Rate for Payer: Humana Commercial |
$97.13
|
| Rate for Payer: Humana KY Medicaid |
$37.58
|
| Rate for Payer: Humana KY Medicaid |
$39.30
|
| Rate for Payer: Kentucky WC Medicaid |
$39.70
|
| Rate for Payer: Kentucky WC Medicaid |
$37.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.56
|
| Rate for Payer: Ohio Health Group HMO |
$81.95
|
| Rate for Payer: Ohio Health Group HMO |
$85.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.85
|
| Rate for Payer: PHCS Commercial |
$109.70
|
| Rate for Payer: PHCS Commercial |
$104.90
|
| Rate for Payer: United Healthcare All Payer |
$100.56
|
| Rate for Payer: United Healthcare All Payer |
$96.16
|
|
|
HEPARIN LOCK FLUSH 10 100U/1ML
|
Facility
|
IP
|
$77.61
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
25002127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$74.51 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.54
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cigna Commercial |
$64.42
|
| Rate for Payer: First Health Commercial |
$73.73
|
| Rate for Payer: Humana Commercial |
$65.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.30
|
| Rate for Payer: Ohio Health Group HMO |
$58.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.55
|
| Rate for Payer: PHCS Commercial |
$74.51
|
| Rate for Payer: United Healthcare All Payer |
$68.30
|
|
|
HEPARIN LOCK FLUSH 10 100U/1ML
|
Facility
|
OP
|
$77.61
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
25002127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$74.51 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Anthem Medicaid |
$26.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.54
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cigna Commercial |
$64.42
|
| Rate for Payer: First Health Commercial |
$73.73
|
| Rate for Payer: Humana Commercial |
$65.97
|
| Rate for Payer: Humana KY Medicaid |
$26.69
|
| Rate for Payer: Kentucky WC Medicaid |
$26.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.30
|
| Rate for Payer: Ohio Health Group HMO |
$58.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.55
|
| Rate for Payer: PHCS Commercial |
$74.51
|
| Rate for Payer: United Healthcare All Payer |
$68.30
|
|
|
HEPARIN SOD 1000U 50000U/5ML V
|
Facility
|
IP
|
$181.67
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$174.40 |
| Rate for Payer: Aetna Commercial |
$139.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Cash Price |
$90.83
|
| Rate for Payer: Cigna Commercial |
$150.79
|
| Rate for Payer: First Health Commercial |
$172.59
|
| Rate for Payer: Humana Commercial |
$154.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.87
|
| Rate for Payer: Ohio Health Group HMO |
$136.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.35
|
| Rate for Payer: PHCS Commercial |
$174.40
|
| Rate for Payer: United Healthcare All Payer |
$159.87
|
|
|
HEPARIN SOD 1000U 50000U/5ML V
|
Facility
|
OP
|
$181.67
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$174.40 |
| Rate for Payer: Aetna Commercial |
$139.89
|
| Rate for Payer: Anthem Medicaid |
$62.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Cash Price |
$90.83
|
| Rate for Payer: Cigna Commercial |
$150.79
|
| Rate for Payer: First Health Commercial |
$172.59
|
| Rate for Payer: Humana Commercial |
$154.42
|
| Rate for Payer: Humana KY Medicaid |
$62.48
|
| Rate for Payer: Kentucky WC Medicaid |
$63.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.87
|
| Rate for Payer: Ohio Health Group HMO |
$136.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.35
|
| Rate for Payer: PHCS Commercial |
$174.40
|
| Rate for Payer: United Healthcare All Payer |
$159.87
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
OP
|
$77.50
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$74.40 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Anthem Medicaid |
$26.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.45
|
| Rate for Payer: Cash Price |
$38.75
|
| Rate for Payer: Cigna Commercial |
$64.33
|
| Rate for Payer: First Health Commercial |
$73.62
|
| Rate for Payer: Humana Commercial |
$65.88
|
| Rate for Payer: Humana KY Medicaid |
$26.65
|
| Rate for Payer: Kentucky WC Medicaid |
$26.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.20
|
| Rate for Payer: Ohio Health Group HMO |
$58.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.48
|
| Rate for Payer: PHCS Commercial |
$74.40
|
| Rate for Payer: United Healthcare All Payer |
$68.20
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Professional
|
Both
|
$19.31
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Aetna Commercial |
$0.34
|
| Rate for Payer: Ambetter Exchange |
$0.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.26
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.22
|
| Rate for Payer: Multiplan PHCS |
$11.59
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.29
|
| Rate for Payer: UHCCP Medicaid |
$6.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.22
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
IP
|
$19.31
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
636T0035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$18.54 |
| Rate for Payer: Aetna Commercial |
$14.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.06
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cigna Commercial |
$16.03
|
| Rate for Payer: First Health Commercial |
$18.34
|
| Rate for Payer: Humana Commercial |
$16.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.99
|
| Rate for Payer: Ohio Health Group HMO |
$14.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.32
|
| Rate for Payer: PHCS Commercial |
$18.54
|
| Rate for Payer: United Healthcare All Payer |
$16.99
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
OP
|
$19.31
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$18.54 |
| Rate for Payer: Aetna Commercial |
$14.87
|
| Rate for Payer: Anthem Medicaid |
$6.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.06
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cigna Commercial |
$16.03
|
| Rate for Payer: First Health Commercial |
$18.34
|
| Rate for Payer: Humana Commercial |
$16.41
|
| Rate for Payer: Humana KY Medicaid |
$6.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.99
|
| Rate for Payer: Ohio Health Group HMO |
$14.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.32
|
| Rate for Payer: PHCS Commercial |
$18.54
|
| Rate for Payer: United Healthcare All Payer |
$16.99
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
OP
|
$19.31
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
636T0035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$18.54 |
| Rate for Payer: Aetna Commercial |
$14.87
|
| Rate for Payer: Anthem Medicaid |
$6.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.06
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cigna Commercial |
$16.03
|
| Rate for Payer: First Health Commercial |
$18.34
|
| Rate for Payer: Humana Commercial |
$16.41
|
| Rate for Payer: Humana KY Medicaid |
$6.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.99
|
| Rate for Payer: Ohio Health Group HMO |
$14.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.32
|
| Rate for Payer: PHCS Commercial |
$18.54
|
| Rate for Payer: United Healthcare All Payer |
$16.99
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
IP
|
$19.31
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$18.54 |
| Rate for Payer: Aetna Commercial |
$14.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.06
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cigna Commercial |
$16.03
|
| Rate for Payer: First Health Commercial |
$18.34
|
| Rate for Payer: Humana Commercial |
$16.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.99
|
| Rate for Payer: Ohio Health Group HMO |
$14.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.32
|
| Rate for Payer: PHCS Commercial |
$18.54
|
| Rate for Payer: United Healthcare All Payer |
$16.99
|
|
|
HEPARIN SQ 1000U [5000U VL]
|
Facility
|
IP
|
$77.50
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$74.40 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.45
|
| Rate for Payer: Cash Price |
$38.75
|
| Rate for Payer: Cigna Commercial |
$64.33
|
| Rate for Payer: First Health Commercial |
$73.62
|
| Rate for Payer: Humana Commercial |
$65.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.20
|
| Rate for Payer: Ohio Health Group HMO |
$58.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.48
|
| Rate for Payer: PHCS Commercial |
$74.40
|
| Rate for Payer: United Healthcare All Payer |
$68.20
|
|
|
HEPARSOD 1000U 5000U/ML 10MLVL
|
Facility
|
IP
|
$124.39
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$119.41 |
| Rate for Payer: Aetna Commercial |
$95.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.02
|
| Rate for Payer: Cash Price |
$62.20
|
| Rate for Payer: Cigna Commercial |
$103.24
|
| Rate for Payer: First Health Commercial |
$118.17
|
| Rate for Payer: Humana Commercial |
$105.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.46
|
| Rate for Payer: Ohio Health Group HMO |
$93.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.83
|
| Rate for Payer: PHCS Commercial |
$119.41
|
| Rate for Payer: United Healthcare All Payer |
$109.46
|
|
|
HEPARSOD 1000U 5000U/ML 10MLVL
|
Facility
|
OP
|
$124.39
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
25002129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$119.41 |
| Rate for Payer: Aetna Commercial |
$95.78
|
| Rate for Payer: Anthem Medicaid |
$42.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.02
|
| Rate for Payer: Cash Price |
$62.20
|
| Rate for Payer: Cigna Commercial |
$103.24
|
| Rate for Payer: First Health Commercial |
$118.17
|
| Rate for Payer: Humana Commercial |
$105.73
|
| Rate for Payer: Humana KY Medicaid |
$42.78
|
| Rate for Payer: Kentucky WC Medicaid |
$43.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.46
|
| Rate for Payer: Ohio Health Group HMO |
$93.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.83
|
| Rate for Payer: PHCS Commercial |
$119.41
|
| Rate for Payer: United Healthcare All Payer |
$109.46
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
HCPCS 47130
|
| Hospital Charge Code |
76101950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$4,560.00 |
| Rate for Payer: Aetna Commercial |
$3,657.50
|
| Rate for Payer: Anthem Medicaid |
$1,633.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,705.00
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cigna Commercial |
$3,942.50
|
| Rate for Payer: First Health Commercial |
$4,512.50
|
| Rate for Payer: Humana Commercial |
$4,037.50
|
| Rate for Payer: Humana KY Medicaid |
$1,633.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,895.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,425.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,180.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,132.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,277.50
|
| Rate for Payer: PHCS Commercial |
$4,560.00
|
| Rate for Payer: United Healthcare All Payer |
$4,180.00
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47120
|
| Hospital Charge Code |
76101949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$968.70 |
| Max. Negotiated Rate |
$3,365.98 |
| Rate for Payer: Aetna Commercial |
$3,365.98
|
| Rate for Payer: Ambetter Exchange |
$2,218.62
|
| Rate for Payer: Anthem Medicaid |
$968.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,218.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,218.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,662.34
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$3,145.71
|
| Rate for Payer: Healthspan PPO |
$2,838.59
|
| Rate for Payer: Humana Medicaid |
$968.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,971.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,218.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,218.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$988.07
|
| Rate for Payer: Molina Healthcare Passport |
$968.70
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,884.21
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$978.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,218.62
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47120
|
| Hospital Charge Code |
76101949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,080.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47120
|
| Hospital Charge Code |
76101949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,080.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
HCPCS 47130
|
| Hospital Charge Code |
76101950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$4,560.00 |
| Rate for Payer: Aetna Commercial |
$3,657.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,705.00
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cigna Commercial |
$3,942.50
|
| Rate for Payer: First Health Commercial |
$4,512.50
|
| Rate for Payer: Humana Commercial |
$4,037.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,895.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,180.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,132.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,277.50
|
| Rate for Payer: PHCS Commercial |
$4,560.00
|
| Rate for Payer: United Healthcare All Payer |
$4,180.00
|
|
|
HEPATECTOMY - RESECTION OF LI
|
Professional
|
Both
|
$4,750.00
|
|
|
Service Code
|
HCPCS 47130
|
| Hospital Charge Code |
76101950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,535.32 |
| Max. Negotiated Rate |
$4,838.51 |
| Rate for Payer: Aetna Commercial |
$4,838.51
|
| Rate for Payer: Ambetter Exchange |
$3,138.80
|
| Rate for Payer: Anthem Medicaid |
$1,535.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3,138.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,138.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,766.56
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cigna Commercial |
$4,540.47
|
| Rate for Payer: Healthspan PPO |
$4,080.40
|
| Rate for Payer: Humana Medicaid |
$1,535.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,228.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3,138.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,138.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,566.03
|
| Rate for Payer: Molina Healthcare Passport |
$1,535.32
|
| Rate for Payer: Multiplan PHCS |
$2,850.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,080.44
|
| Rate for Payer: UHCCP Medicaid |
$1,662.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,550.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,138.80
|
|
|
HEPATECTOMY - RESECTION OF L(P
|
Professional
|
Both
|
$4,750.00
|
|
|
Service Code
|
HCPCS 47130
|
| Hospital Charge Code |
761P1950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,535.32 |
| Max. Negotiated Rate |
$4,838.51 |
| Rate for Payer: Aetna Commercial |
$4,838.51
|
| Rate for Payer: Ambetter Exchange |
$3,138.80
|
| Rate for Payer: Anthem Medicaid |
$1,535.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3,138.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,138.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,766.56
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cash Price |
$2,375.00
|
| Rate for Payer: Cigna Commercial |
$4,540.47
|
| Rate for Payer: Healthspan PPO |
$4,080.40
|
| Rate for Payer: Humana Medicaid |
$1,535.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,228.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3,138.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,138.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,566.03
|
| Rate for Payer: Molina Healthcare Passport |
$1,535.32
|
| Rate for Payer: Multiplan PHCS |
$2,850.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,080.44
|
| Rate for Payer: UHCCP Medicaid |
$1,662.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,550.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,138.80
|
|
