|
HEPATECTOMY - RESECTION OF L(P
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47120
|
| Hospital Charge Code |
761P1949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$968.70 |
| Max. Negotiated Rate |
$3,365.98 |
| 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
|
|
|
HEPATIC FUNCTION PANEL
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
30000014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$69.60 |
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Ambetter Exchange |
$8.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.80
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$7.19
|
| Rate for Payer: Healthspan PPO |
$6.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Multiplan PHCS |
$69.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.62
|
| Rate for Payer: UHCCP Medicaid |
$40.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.17
|
|
|
HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
30000014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Humana KY Medicaid |
$8.17
|
| Rate for Payer: Humana Medicare Advantage |
$8.17
|
| Rate for Payer: Kentucky WC Medicaid |
$8.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.04
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
30000014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.04
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (82247) BILIRUBIN, DIRECT (82248) PHOSPHATASE, ALKALINE (84075) PROTEIN, TOTAL (84155) TRANSFERASE, ALANINE AMINO (ALT) (SGPT) (84460) TRANSFERASE, ASPARTATE AMINO (AST) (SGOT) (84450)
|
Facility
|
OP
|
$11.44
|
|
|
Service Code
|
CPT 80076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$11.44 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.03
|
| Rate for Payer: Humana Medicare Advantage |
$8.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.80
|
|
|
HEPATIC VISCERAL ARTERIOGRAM
|
Facility
|
OP
|
$8,414.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32000385
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$2,893.57 |
| Max. Negotiated Rate |
$8,077.44 |
| Rate for Payer: Aetna Commercial |
$6,478.78
|
| Rate for Payer: Anthem Medicaid |
$2,893.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,562.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$4,207.00
|
| Rate for Payer: Cash Price |
$4,207.00
|
| Rate for Payer: Cigna Commercial |
$6,983.62
|
| Rate for Payer: First Health Commercial |
$7,993.30
|
| Rate for Payer: Humana Commercial |
$7,151.90
|
| Rate for Payer: Humana KY Medicaid |
$2,893.57
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,899.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,209.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,951.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,404.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,731.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,320.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,805.66
|
| Rate for Payer: PHCS Commercial |
$8,077.44
|
| Rate for Payer: United Healthcare All Payer |
$7,404.32
|
|
|
HEPATIC VISCERAL ARTERIOGRAM
|
Facility
|
IP
|
$8,414.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32000385
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$2,524.20 |
| Max. Negotiated Rate |
$8,077.44 |
| Rate for Payer: Aetna Commercial |
$6,478.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,562.92
|
| Rate for Payer: Cash Price |
$4,207.00
|
| Rate for Payer: Cigna Commercial |
$6,983.62
|
| Rate for Payer: First Health Commercial |
$7,993.30
|
| Rate for Payer: Humana Commercial |
$7,151.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,899.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,209.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,404.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,731.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,320.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,805.66
|
| Rate for Payer: PHCS Commercial |
$8,077.44
|
| Rate for Payer: United Healthcare All Payer |
$7,404.32
|
|
|
HEPATITIS A AB (IGM)
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
30001187
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
HEPATITIS A AB (IGM)
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
30001187
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$11.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.26
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$11.26
|
| Rate for Payer: Humana Medicare Advantage |
$11.26
|
| Rate for Payer: Kentucky WC Medicaid |
$11.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
HEPATITIS A AB TOTAL
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
30001186
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
HEPATITIS A AB TOTAL
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
30001186
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$12.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.39
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$12.39
|
| Rate for Payer: Humana Medicare Advantage |
$12.39
|
| Rate for Payer: Kentucky WC Medicaid |
$12.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
HEPATITIS BC AB TOTAL
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
30001182
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
HEPATITIS BC AB TOTAL
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
30001182
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
HEPATITIS B INJ 20 YRS +
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
77000052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Ambetter Exchange |
$70.38
|
| Rate for Payer: Anthem Medicaid |
$65.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.46
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Humana Medicaid |
$65.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$70.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.42
|
| Rate for Payer: Molina Healthcare Passport |
$65.12
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.49
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.38
|
|
|
HEPATITIS B INJ 20 YRS +
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
77000052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
HEPATITIS B INJ 20 YRS +
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
77000052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
HEPATITIS B INJ 20 YRS +(T
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
770T0052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Aetna Commercial |
$262.18
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem Medicaid |
$117.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.58
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cigna Commercial |
$282.61
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$323.47
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana Commercial |
$289.42
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Humana KY Medicaid |
$117.09
|
| Rate for Payer: Kentucky WC Medicaid |
$118.29
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.63
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group HMO |
$255.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.94
|
| Rate for Payer: PHCS Commercial |
$326.87
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$299.63
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
HEPATITIS B INJ 20 YRS +(T
|
Facility
|
OP
|
$340.49
|
|
|
Service Code
|
HCPCS 90746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.15 |
| Max. Negotiated Rate |
$326.87 |
| Rate for Payer: Aetna Commercial |
$262.18
|
| Rate for Payer: Anthem Medicaid |
$117.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.58
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cigna Commercial |
$282.61
|
| Rate for Payer: First Health Commercial |
$323.47
|
| Rate for Payer: Humana Commercial |
$289.42
|
| Rate for Payer: Humana KY Medicaid |
$117.09
|
| Rate for Payer: Kentucky WC Medicaid |
$118.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.63
|
| Rate for Payer: Ohio Health Group HMO |
$255.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.94
|
| Rate for Payer: PHCS Commercial |
$326.87
|
| Rate for Payer: United Healthcare All Payer |
$299.63
|
|
|
HEPATITIS B INJ 20 YRS +(T
|
Facility
|
IP
|
$340.49
|
|
|
Service Code
|
HCPCS 90746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.15 |
| Max. Negotiated Rate |
$326.87 |
| Rate for Payer: Aetna Commercial |
$262.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.58
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cigna Commercial |
$282.61
|
| Rate for Payer: First Health Commercial |
$323.47
|
| Rate for Payer: Humana Commercial |
$289.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.63
|
| Rate for Payer: Ohio Health Group HMO |
$255.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.94
|
| Rate for Payer: PHCS Commercial |
$326.87
|
| Rate for Payer: United Healthcare All Payer |
$299.63
|
|
|
HEPATITIS B INJ 20 YRS +(T
|
Facility
|
IP
|
$340.49
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
770T0052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.15 |
| Max. Negotiated Rate |
$326.87 |
| Rate for Payer: Aetna Commercial |
$262.18
|
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.58
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cigna Commercial |
$282.61
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: First Health Commercial |
$323.47
|
| Rate for Payer: Humana Commercial |
$289.42
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group HMO |
$255.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.94
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: PHCS Commercial |
$326.87
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
| Rate for Payer: United Healthcare All Payer |
$299.63
|
|
|
HEPATITIS B INJ NEWBORN-11YR
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
77000051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$97.80 |
| Rate for Payer: Ambetter Exchange |
$31.67
|
| Rate for Payer: Anthem Medicaid |
$24.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.00
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Healthspan PPO |
$32.89
|
| Rate for Payer: Humana Medicaid |
$24.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.70
|
| Rate for Payer: Molina Healthcare Passport |
$24.22
|
| Rate for Payer: Multiplan PHCS |
$97.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.17
|
| Rate for Payer: UHCCP Medicaid |
$57.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.67
|
|
|
HEPATITIS B INJ NEWBORN-11YR
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
77000051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$56.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$56.06
|
| Rate for Payer: Kentucky WC Medicaid |
$56.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
HEPATITIS B INJ NEWBORN-11YR
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
77000051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
HEPATITIS B INJ NEWBORN-11YR(T
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
770T0051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$56.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$56.06
|
| Rate for Payer: Kentucky WC Medicaid |
$56.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
HEPATITIS B INJ NEWBORN-11YR(T
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
770T0051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
