|
GI LEVEL 1
|
Facility
|
IP
|
$1,699.00
|
|
| Hospital Charge Code |
36001238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
GI LEVEL 2
|
Facility
|
OP
|
$2,515.00
|
|
| Hospital Charge Code |
36001239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$754.50 |
| Max. Negotiated Rate |
$2,414.40 |
| Rate for Payer: Aetna Commercial |
$1,936.55
|
| Rate for Payer: Anthem Medicaid |
$864.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,961.70
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cigna Commercial |
$2,087.45
|
| Rate for Payer: First Health Commercial |
$2,389.25
|
| Rate for Payer: Humana Commercial |
$2,137.75
|
| Rate for Payer: Humana KY Medicaid |
$864.91
|
| Rate for Payer: Kentucky WC Medicaid |
$873.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,062.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$882.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,213.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,886.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,188.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.35
|
| Rate for Payer: PHCS Commercial |
$2,414.40
|
| Rate for Payer: United Healthcare All Payer |
$2,213.20
|
|
|
GI LEVEL 2
|
Facility
|
IP
|
$2,515.00
|
|
| Hospital Charge Code |
36001239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$754.50 |
| Max. Negotiated Rate |
$2,414.40 |
| Rate for Payer: Aetna Commercial |
$1,936.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,961.70
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cigna Commercial |
$2,087.45
|
| Rate for Payer: First Health Commercial |
$2,389.25
|
| Rate for Payer: Humana Commercial |
$2,137.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,062.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,213.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,886.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,188.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.35
|
| Rate for Payer: PHCS Commercial |
$2,414.40
|
| Rate for Payer: United Healthcare All Payer |
$2,213.20
|
|
|
GI LEVEL 3
|
Facility
|
IP
|
$3,207.00
|
|
| Hospital Charge Code |
36001240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$962.10 |
| Max. Negotiated Rate |
$3,078.72 |
| Rate for Payer: Aetna Commercial |
$2,469.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,501.46
|
| Rate for Payer: Cash Price |
$1,603.50
|
| Rate for Payer: Cigna Commercial |
$2,661.81
|
| Rate for Payer: First Health Commercial |
$3,046.65
|
| Rate for Payer: Humana Commercial |
$2,725.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,629.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,366.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$962.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,822.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,565.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,790.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,212.83
|
| Rate for Payer: PHCS Commercial |
$3,078.72
|
| Rate for Payer: United Healthcare All Payer |
$2,822.16
|
|
|
GI LEVEL 3
|
Facility
|
OP
|
$3,207.00
|
|
| Hospital Charge Code |
36001240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$962.10 |
| Max. Negotiated Rate |
$3,078.72 |
| Rate for Payer: Aetna Commercial |
$2,469.39
|
| Rate for Payer: Anthem Medicaid |
$1,102.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,501.46
|
| Rate for Payer: Cash Price |
$1,603.50
|
| Rate for Payer: Cigna Commercial |
$2,661.81
|
| Rate for Payer: First Health Commercial |
$3,046.65
|
| Rate for Payer: Humana Commercial |
$2,725.95
|
| Rate for Payer: Humana KY Medicaid |
$1,102.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,114.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,629.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,366.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$962.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,125.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,822.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,565.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,790.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,212.83
|
| Rate for Payer: PHCS Commercial |
$3,078.72
|
| Rate for Payer: United Healthcare All Payer |
$2,822.16
|
|
|
GI LEVEL 4
|
Facility
|
IP
|
$3,690.00
|
|
| Hospital Charge Code |
36001241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,107.00 |
| Max. Negotiated Rate |
$3,542.40 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$3,062.70
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Humana Commercial |
$3,136.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,025.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,723.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,107.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,247.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,767.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,210.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,546.10
|
| Rate for Payer: PHCS Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Payer |
$3,247.20
|
|
|
GI LEVEL 4
|
Facility
|
OP
|
$3,690.00
|
|
| Hospital Charge Code |
36001241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,107.00 |
| Max. Negotiated Rate |
$3,542.40 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Anthem Medicaid |
$1,268.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$3,062.70
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Humana Commercial |
$3,136.50
|
| Rate for Payer: Humana KY Medicaid |
$1,268.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,025.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,723.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,107.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,294.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,247.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,767.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,210.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,546.10
|
| Rate for Payer: PHCS Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Payer |
$3,247.20
|
|
|
GI LEVEL MOD TO COMPLEX
|
Facility
|
IP
|
$8,702.00
|
|
| Hospital Charge Code |
36001261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,610.60 |
| Max. Negotiated Rate |
$8,353.92 |
| Rate for Payer: Aetna Commercial |
$6,700.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,787.56
|
| Rate for Payer: Cash Price |
$4,351.00
|
| Rate for Payer: Cigna Commercial |
$7,222.66
|
| Rate for Payer: First Health Commercial |
$8,266.90
|
| Rate for Payer: Humana Commercial |
$7,396.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,135.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,422.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,610.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,657.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,526.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,961.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,570.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,004.38
|
| Rate for Payer: PHCS Commercial |
$8,353.92
|
| Rate for Payer: United Healthcare All Payer |
$7,657.76
|
|
|
GI LEVEL MOD TO COMPLEX
|
Facility
|
OP
|
$8,702.00
|
|
| Hospital Charge Code |
36001261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,610.60 |
| Max. Negotiated Rate |
$8,353.92 |
| Rate for Payer: Aetna Commercial |
$6,700.54
|
| Rate for Payer: Anthem Medicaid |
$2,992.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,787.56
|
| Rate for Payer: Cash Price |
$4,351.00
|
| Rate for Payer: Cigna Commercial |
$7,222.66
|
| Rate for Payer: First Health Commercial |
$8,266.90
|
| Rate for Payer: Humana Commercial |
$7,396.70
|
| Rate for Payer: Humana KY Medicaid |
$2,992.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,023.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,135.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,422.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,610.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,052.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,657.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,526.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,961.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,570.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,004.38
|
| Rate for Payer: PHCS Commercial |
$8,353.92
|
| Rate for Payer: United Healthcare All Payer |
$7,657.76
|
|
|
GI TRC IMG INTRAL COLON I&R
|
Facility
|
IP
|
$3,363.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,008.90 |
| Max. Negotiated Rate |
$3,228.48 |
| Rate for Payer: Aetna Commercial |
$2,589.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.14
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cigna Commercial |
$2,791.29
|
| Rate for Payer: First Health Commercial |
$3,194.85
|
| Rate for Payer: Humana Commercial |
$2,858.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,757.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,481.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,008.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.47
|
| Rate for Payer: PHCS Commercial |
$3,228.48
|
| Rate for Payer: United Healthcare All Payer |
$2,959.44
|
|
|
GI TRC IMG INTRAL COLON I&R
|
Facility
|
OP
|
$3,363.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$3,228.48 |
| Rate for Payer: Aetna Commercial |
$2,589.51
|
| Rate for Payer: Anthem Medicaid |
$1,156.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cigna Commercial |
$2,791.29
|
| Rate for Payer: First Health Commercial |
$3,194.85
|
| Rate for Payer: Humana Commercial |
$2,858.55
|
| Rate for Payer: Humana KY Medicaid |
$1,156.54
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,168.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,757.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,481.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,179.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.47
|
| Rate for Payer: PHCS Commercial |
$3,228.48
|
| Rate for Payer: United Healthcare All Payer |
$2,959.44
|
|
|
GI TRC IMG INTRAL COLON I&R
|
Professional
|
Both
|
$3,363.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$733.25 |
| Max. Negotiated Rate |
$2,017.80 |
| Rate for Payer: Ambetter Exchange |
$759.90
|
| Rate for Payer: Anthem Medicaid |
$733.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$759.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$759.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$911.88
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Humana Medicaid |
$733.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$747.91
|
| Rate for Payer: Molina Healthcare Passport |
$733.25
|
| Rate for Payer: Multiplan PHCS |
$2,017.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$987.87
|
| Rate for Payer: UHCCP Medicaid |
$1,177.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$740.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$759.90
|
|
|
GI TRC IMG INTRAL COLON I&R (P
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
750P0009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$987.87 |
| Rate for Payer: Ambetter Exchange |
$759.90
|
| Rate for Payer: Anthem Medicaid |
$733.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$759.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$759.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$911.88
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Humana Medicaid |
$733.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$747.91
|
| Rate for Payer: Molina Healthcare Passport |
$733.25
|
| Rate for Payer: Multiplan PHCS |
$87.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$987.87
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$740.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$759.90
|
|
|
GI TRC IMG INTRAL COLON I&R (T
|
Facility
|
OP
|
$3,218.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
750T0009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$3,089.28 |
| Rate for Payer: Aetna Commercial |
$2,477.86
|
| Rate for Payer: Anthem Medicaid |
$1,106.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$1,609.00
|
| Rate for Payer: Cash Price |
$1,609.00
|
| Rate for Payer: Cigna Commercial |
$2,670.94
|
| Rate for Payer: First Health Commercial |
$3,057.10
|
| Rate for Payer: Humana Commercial |
$2,735.30
|
| Rate for Payer: Humana KY Medicaid |
$1,106.67
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,117.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,638.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,374.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,128.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,831.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,413.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,799.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.42
|
| Rate for Payer: PHCS Commercial |
$3,089.28
|
| Rate for Payer: United Healthcare All Payer |
$2,831.84
|
|
|
GI TRC IMG INTRAL COLON I&R (T
|
Facility
|
IP
|
$3,218.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
750T0009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$965.40 |
| Max. Negotiated Rate |
$3,089.28 |
| Rate for Payer: Aetna Commercial |
$2,477.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.04
|
| Rate for Payer: Cash Price |
$1,609.00
|
| Rate for Payer: Cigna Commercial |
$2,670.94
|
| Rate for Payer: First Health Commercial |
$3,057.10
|
| Rate for Payer: Humana Commercial |
$2,735.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,638.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,374.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,831.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,413.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,799.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.42
|
| Rate for Payer: PHCS Commercial |
$3,089.28
|
| Rate for Payer: United Healthcare All Payer |
$2,831.84
|
|
|
GI: UPPER W/AIR CONTRAST
|
Professional
|
Both
|
$994.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
32000133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$596.40 |
| Rate for Payer: Aetna Commercial |
$186.10
|
| Rate for Payer: Ambetter Exchange |
$123.31
|
| Rate for Payer: Anthem Medicaid |
$104.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$123.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$123.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.97
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cigna Commercial |
$157.57
|
| Rate for Payer: Healthspan PPO |
$174.38
|
| Rate for Payer: Humana Medicaid |
$104.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$123.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.11
|
| Rate for Payer: Molina Healthcare Passport |
$104.03
|
| Rate for Payer: Multiplan PHCS |
$596.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$160.30
|
| Rate for Payer: UHCCP Medicaid |
$347.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$123.31
|
|
|
GI: UPPER W/AIR CONTRAST
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
32000133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$954.24 |
| Rate for Payer: Aetna Commercial |
$765.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$775.32
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cigna Commercial |
$825.02
|
| Rate for Payer: First Health Commercial |
$944.30
|
| Rate for Payer: Humana Commercial |
$844.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$733.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$874.72
|
| Rate for Payer: Ohio Health Group HMO |
$745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.86
|
| Rate for Payer: PHCS Commercial |
$954.24
|
| Rate for Payer: United Healthcare All Payer |
$874.72
|
|
|
GI: UPPER W/AIR CONTRAST
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
32000133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$954.24 |
| Rate for Payer: Aetna Commercial |
$765.38
|
| Rate for Payer: Anthem Medicaid |
$341.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$775.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cigna Commercial |
$825.02
|
| Rate for Payer: First Health Commercial |
$944.30
|
| Rate for Payer: Humana Commercial |
$844.90
|
| Rate for Payer: Humana KY Medicaid |
$341.84
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$345.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$733.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$348.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$874.72
|
| Rate for Payer: Ohio Health Group HMO |
$745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.86
|
| Rate for Payer: PHCS Commercial |
$954.24
|
| Rate for Payer: United Healthcare All Payer |
$874.72
|
|
|
GI: UPPER W/AIR CONTRAST(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
320P0133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$186.10 |
| Rate for Payer: Aetna Commercial |
$186.10
|
| Rate for Payer: Ambetter Exchange |
$123.31
|
| Rate for Payer: Anthem Medicaid |
$104.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$123.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$123.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.97
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$157.57
|
| Rate for Payer: Healthspan PPO |
$174.38
|
| Rate for Payer: Humana Medicaid |
$104.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$123.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.11
|
| Rate for Payer: Molina Healthcare Passport |
$104.03
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$160.30
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$123.31
|
|
|
GI: UPPER W/AIR CONTRAST(T
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
320T0133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$858.24 |
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Anthem Medicaid |
$307.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$742.02
|
| Rate for Payer: First Health Commercial |
$849.30
|
| Rate for Payer: Humana Commercial |
$759.90
|
| Rate for Payer: Humana KY Medicaid |
$307.45
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$310.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$313.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$786.72
|
| Rate for Payer: Ohio Health Group HMO |
$670.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$777.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.86
|
| Rate for Payer: PHCS Commercial |
$858.24
|
| Rate for Payer: United Healthcare All Payer |
$786.72
|
|
|
GI: UPPER W/AIR CONTRAST(T
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
320T0133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$858.24 |
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.32
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$742.02
|
| Rate for Payer: First Health Commercial |
$849.30
|
| Rate for Payer: Humana Commercial |
$759.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$786.72
|
| Rate for Payer: Ohio Health Group HMO |
$670.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$777.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.86
|
| Rate for Payer: PHCS Commercial |
$858.24
|
| Rate for Payer: United Healthcare All Payer |
$786.72
|
|
|
GLASSIA 10MG (1000MG VL)
|
Facility
|
IP
|
$3,597.00
|
|
|
Service Code
|
HCPCS J0257
|
| Hospital Charge Code |
25001850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,079.10 |
| Max. Negotiated Rate |
$3,453.12 |
| Rate for Payer: Aetna Commercial |
$2,769.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,805.66
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$2,985.51
|
| Rate for Payer: First Health Commercial |
$3,417.15
|
| Rate for Payer: Humana Commercial |
$3,057.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,949.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,654.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,079.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,165.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,697.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,877.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,129.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,481.93
|
| Rate for Payer: PHCS Commercial |
$3,453.12
|
| Rate for Payer: United Healthcare All Payer |
$3,165.36
|
|
|
GLASSIA 10MG (1000MG VL)
|
Facility
|
OP
|
$3,597.00
|
|
|
Service Code
|
HCPCS J0257
|
| Hospital Charge Code |
25001850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$3,453.12 |
| Rate for Payer: Aetna Commercial |
$2,769.69
|
| Rate for Payer: Anthem Medicaid |
$1,237.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,805.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.71
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$2,985.51
|
| Rate for Payer: First Health Commercial |
$3,417.15
|
| Rate for Payer: Humana Commercial |
$3,057.45
|
| Rate for Payer: Humana KY Medicaid |
$1,237.01
|
| Rate for Payer: Humana Medicare Advantage |
$5.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,249.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,949.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,654.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,261.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,165.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,697.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,877.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,129.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,481.93
|
| Rate for Payer: PHCS Commercial |
$3,453.12
|
| Rate for Payer: United Healthcare All Payer |
$3,165.36
|
|
|
GLEEVEC 100MG TABLET
|
Facility
|
IP
|
$510.34
|
|
|
Service Code
|
NDC 78040134
|
| Hospital Charge Code |
25000722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.10 |
| Max. Negotiated Rate |
$489.93 |
| Rate for Payer: Aetna Commercial |
$392.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.07
|
| Rate for Payer: Cash Price |
$255.17
|
| Rate for Payer: Cigna Commercial |
$423.58
|
| Rate for Payer: First Health Commercial |
$484.82
|
| Rate for Payer: Humana Commercial |
$433.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$418.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.10
|
| Rate for Payer: Ohio Health Group HMO |
$382.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.13
|
| Rate for Payer: PHCS Commercial |
$489.93
|
| Rate for Payer: United Healthcare All Payer |
$449.10
|
|
|
GLEEVEC 100MG TABLET
|
Facility
|
OP
|
$510.34
|
|
|
Service Code
|
NDC 78040134
|
| Hospital Charge Code |
25000722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.10 |
| Max. Negotiated Rate |
$489.93 |
| Rate for Payer: Aetna Commercial |
$392.96
|
| Rate for Payer: Anthem Medicaid |
$175.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.07
|
| Rate for Payer: Cash Price |
$255.17
|
| Rate for Payer: Cigna Commercial |
$423.58
|
| Rate for Payer: First Health Commercial |
$484.82
|
| Rate for Payer: Humana Commercial |
$433.79
|
| Rate for Payer: Humana KY Medicaid |
$175.51
|
| Rate for Payer: Kentucky WC Medicaid |
$177.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$418.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.10
|
| Rate for Payer: Ohio Health Group HMO |
$382.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.13
|
| Rate for Payer: PHCS Commercial |
$489.93
|
| Rate for Payer: United Healthcare All Payer |
$449.10
|
|
