|
HEPATITIS BS AB ANTIBODY
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
30001184
|
|
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 BS AB ANTIBODY
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
30001184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$10.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.74
|
| 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 |
$10.74
|
| Rate for Payer: Humana Medicare Advantage |
$10.74
|
| Rate for Payer: Kentucky WC Medicaid |
$10.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.95
|
| 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 SURFACE AG CONF
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 87341
|
| Hospital Charge Code |
30001980
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.55
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
HEPATITIS B SURFACE AG CONF
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 87341
|
| Hospital Charge Code |
30001980
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem Medicaid |
$10.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.33
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Humana KY Medicaid |
$10.33
|
| Rate for Payer: Humana Medicare Advantage |
$10.33
|
| Rate for Payer: Kentucky WC Medicaid |
$10.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.55
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
HEPATITIS B SURFACE ANTIGEN
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
30001350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$10.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$10.33
|
| Rate for Payer: Humana Medicare Advantage |
$10.33
|
| Rate for Payer: Kentucky WC Medicaid |
$10.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.52
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
HEPATITIS B SURFACE ANTIGEN
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
30001350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.52
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
HEPATITIS C ANTIBODY
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
30001789
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Ambetter Exchange |
$14.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$14.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$14.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.12
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$12.71
|
| Rate for Payer: Healthspan PPO |
$13.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$14.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.27
|
| Rate for Payer: Multiplan PHCS |
$88.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.55
|
| Rate for Payer: UHCCP Medicaid |
$51.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.27
|
|
|
HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
30001789
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.43
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
|
HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
30001789
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem Medicaid |
$14.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.27
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Humana KY Medicaid |
$14.27
|
| Rate for Payer: Humana Medicare Advantage |
$14.27
|
| Rate for Payer: Kentucky WC Medicaid |
$14.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.43
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
|
HEPATITIS CORE IGM ANTIBODY
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
30001183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
HEPATITIS CORE IGM ANTIBODY
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
30001183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$11.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.77
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Humana KY Medicaid |
$11.77
|
| Rate for Payer: Humana Medicare Advantage |
$11.77
|
| Rate for Payer: Kentucky WC Medicaid |
$11.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
HEPATOBILIARY
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
34000009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$2,025.60 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Anthem Medicaid |
$725.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$1,055.00
|
| Rate for Payer: Cash Price |
$1,055.00
|
| Rate for Payer: Cigna Commercial |
$1,751.30
|
| Rate for Payer: First Health Commercial |
$2,004.50
|
| Rate for Payer: Humana Commercial |
$1,793.50
|
| Rate for Payer: Humana KY Medicaid |
$725.63
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$733.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,730.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,835.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.90
|
| Rate for Payer: PHCS Commercial |
$2,025.60
|
| Rate for Payer: United Healthcare All Payer |
$1,856.80
|
|
|
HEPATOBILIARY
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
34000009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$1,266.00 |
| Rate for Payer: Ambetter Exchange |
$258.81
|
| Rate for Payer: Anthem Medicaid |
$251.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$310.57
|
| Rate for Payer: Cash Price |
$1,055.00
|
| Rate for Payer: Cash Price |
$1,055.00
|
| Rate for Payer: Cigna Commercial |
$535.55
|
| Rate for Payer: Healthspan PPO |
$356.05
|
| Rate for Payer: Humana Medicaid |
$251.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$258.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$256.36
|
| Rate for Payer: Molina Healthcare Passport |
$251.33
|
| Rate for Payer: Multiplan PHCS |
$1,266.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$336.45
|
| Rate for Payer: UHCCP Medicaid |
$738.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.81
|
|
|
HEPATOBILIARY
|
Facility
|
IP
|
$2,110.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
34000009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$633.00 |
| Max. Negotiated Rate |
$2,025.60 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.80
|
| Rate for Payer: Cash Price |
$1,055.00
|
| Rate for Payer: Cigna Commercial |
$1,751.30
|
| Rate for Payer: First Health Commercial |
$2,004.50
|
| Rate for Payer: Humana Commercial |
$1,793.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,730.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,835.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.90
|
| Rate for Payer: PHCS Commercial |
$2,025.60
|
| Rate for Payer: United Healthcare All Payer |
$1,856.80
|
|
|
HEPATOBILIARY(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
340P0009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$535.55 |
| Rate for Payer: Ambetter Exchange |
$258.81
|
| Rate for Payer: Anthem Medicaid |
$251.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$310.57
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$535.55
|
| Rate for Payer: Healthspan PPO |
$356.05
|
| Rate for Payer: Humana Medicaid |
$251.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$258.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$256.36
|
| Rate for Payer: Molina Healthcare Passport |
$251.33
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$336.45
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.81
|
|
|
HEPATOBILIARY(T
|
Facility
|
OP
|
$1,985.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
340T0009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,905.60 |
| Rate for Payer: Aetna Commercial |
$1,528.45
|
| Rate for Payer: Anthem Medicaid |
$682.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$992.50
|
| Rate for Payer: Cash Price |
$992.50
|
| Rate for Payer: Cigna Commercial |
$1,647.55
|
| Rate for Payer: First Health Commercial |
$1,885.75
|
| Rate for Payer: Humana Commercial |
$1,687.25
|
| Rate for Payer: Humana KY Medicaid |
$682.64
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$689.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$696.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,746.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.65
|
| Rate for Payer: PHCS Commercial |
$1,905.60
|
| Rate for Payer: United Healthcare All Payer |
$1,746.80
|
|
|
HEPATOBILIARY(T
|
Facility
|
IP
|
$1,985.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
340T0009
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$595.50 |
| Max. Negotiated Rate |
$1,905.60 |
| Rate for Payer: Aetna Commercial |
$1,528.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.30
|
| Rate for Payer: Cash Price |
$992.50
|
| Rate for Payer: Cigna Commercial |
$1,647.55
|
| Rate for Payer: First Health Commercial |
$1,885.75
|
| Rate for Payer: Humana Commercial |
$1,687.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,746.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.65
|
| Rate for Payer: PHCS Commercial |
$1,905.60
|
| Rate for Payer: United Healthcare All Payer |
$1,746.80
|
|
|
HEPATOBIL SYST IMAGE W/DRUG
|
Professional
|
Both
|
$4,039.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
34000010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$47.41 |
| Max. Negotiated Rate |
$2,423.40 |
| Rate for Payer: Ambetter Exchange |
$347.17
|
| Rate for Payer: Anthem Medicaid |
$343.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$347.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$347.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$416.60
|
| Rate for Payer: Cash Price |
$2,019.50
|
| Rate for Payer: Cash Price |
$2,019.50
|
| Rate for Payer: Cigna Commercial |
$732.68
|
| Rate for Payer: Healthspan PPO |
$483.97
|
| Rate for Payer: Humana Medicaid |
$343.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$347.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.65
|
| Rate for Payer: Molina Healthcare Passport |
$343.77
|
| Rate for Payer: Multiplan PHCS |
$2,423.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$451.32
|
| Rate for Payer: UHCCP Medicaid |
$1,413.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$347.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$347.17
|
|
|
HEPATOBIL SYST IMAGE W/DRUG
|
Facility
|
IP
|
$4,039.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
34000010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,211.70 |
| Max. Negotiated Rate |
$3,877.44 |
| Rate for Payer: Aetna Commercial |
$3,110.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.42
|
| Rate for Payer: Cash Price |
$2,019.50
|
| Rate for Payer: Cigna Commercial |
$3,352.37
|
| Rate for Payer: First Health Commercial |
$3,837.05
|
| Rate for Payer: Humana Commercial |
$3,433.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,554.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,029.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.91
|
| Rate for Payer: PHCS Commercial |
$3,877.44
|
| Rate for Payer: United Healthcare All Payer |
$3,554.32
|
|
|
HEPATOBIL SYST IMAGE W/DRUG
|
Facility
|
OP
|
$4,039.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
34000010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$497.35 |
| Max. Negotiated Rate |
$3,877.44 |
| Rate for Payer: Aetna Commercial |
$3,110.03
|
| Rate for Payer: Anthem Medicaid |
$1,389.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| Rate for Payer: Cash Price |
$2,019.50
|
| Rate for Payer: Cash Price |
$2,019.50
|
| Rate for Payer: Cigna Commercial |
$3,352.37
|
| Rate for Payer: First Health Commercial |
$3,837.05
|
| Rate for Payer: Humana Commercial |
$3,433.15
|
| Rate for Payer: Humana KY Medicaid |
$1,389.01
|
| Rate for Payer: Humana Medicare Advantage |
$497.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,403.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,554.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,029.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.91
|
| Rate for Payer: PHCS Commercial |
$3,877.44
|
| Rate for Payer: United Healthcare All Payer |
$3,554.32
|
|
|
HEPATOBIL SYST IMAGE W/DRUG(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
340P0010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$732.68 |
| Rate for Payer: Ambetter Exchange |
$347.17
|
| Rate for Payer: Anthem Medicaid |
$343.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$347.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$347.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$416.60
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$732.68
|
| Rate for Payer: Healthspan PPO |
$483.97
|
| Rate for Payer: Humana Medicaid |
$343.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$347.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.65
|
| Rate for Payer: Molina Healthcare Passport |
$343.77
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$451.32
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$347.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$347.17
|
|
|
HEPATOBIL SYST IMAGE W/DRUG(T
|
Facility
|
OP
|
$3,914.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
340T0010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$497.35 |
| Max. Negotiated Rate |
$3,757.44 |
| Rate for Payer: Aetna Commercial |
$3,013.78
|
| Rate for Payer: Anthem Medicaid |
$1,346.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,052.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| Rate for Payer: Cash Price |
$1,957.00
|
| Rate for Payer: Cash Price |
$1,957.00
|
| Rate for Payer: Cigna Commercial |
$3,248.62
|
| Rate for Payer: First Health Commercial |
$3,718.30
|
| Rate for Payer: Humana Commercial |
$3,326.90
|
| Rate for Payer: Humana KY Medicaid |
$1,346.02
|
| Rate for Payer: Humana Medicare Advantage |
$497.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,359.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,209.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,888.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,444.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,405.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.66
|
| Rate for Payer: PHCS Commercial |
$3,757.44
|
| Rate for Payer: United Healthcare All Payer |
$3,444.32
|
|
|
HEPATOBIL SYST IMAGE W/DRUG(T
|
Facility
|
IP
|
$3,914.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
340T0010
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,174.20 |
| Max. Negotiated Rate |
$3,757.44 |
| Rate for Payer: Aetna Commercial |
$3,013.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,052.92
|
| Rate for Payer: Cash Price |
$1,957.00
|
| Rate for Payer: Cigna Commercial |
$3,248.62
|
| Rate for Payer: First Health Commercial |
$3,718.30
|
| Rate for Payer: Humana Commercial |
$3,326.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,209.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,888.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,444.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,405.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.66
|
| Rate for Payer: PHCS Commercial |
$3,757.44
|
| Rate for Payer: United Healthcare All Payer |
$3,444.32
|
|
|
HEP A VACCINE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
77000010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$253.44 |
| Rate for Payer: Aetna Commercial |
$203.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.92
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$219.12
|
| Rate for Payer: First Health Commercial |
$250.80
|
| Rate for Payer: Humana Commercial |
$224.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$216.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$232.32
|
| Rate for Payer: Ohio Health Group HMO |
$198.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$211.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.16
|
| Rate for Payer: PHCS Commercial |
$253.44
|
| Rate for Payer: United Healthcare All Payer |
$232.32
|
|
|
HEP A VACCINE
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
77000010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Ambetter Exchange |
$72.68
|
| Rate for Payer: Anthem Medicaid |
$65.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.22
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Humana Medicaid |
$65.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.01
|
| Rate for Payer: Molina Healthcare Passport |
$65.70
|
| Rate for Payer: Multiplan PHCS |
$158.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.48
|
| Rate for Payer: UHCCP Medicaid |
$92.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.68
|
|
