|
COLACE (DOCUSATE SO 100MG/1CAP
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 904718361
|
| Hospital Charge Code |
25000441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
COLAZAL 750 MGA CAPSULE
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 54007928
|
| Hospital Charge Code |
25000443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem Medicaid |
$1.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Humana KY Medicaid |
$1.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
COLAZAL 750 MGA CAPSULE
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 54007928
|
| Hospital Charge Code |
25000443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
COLCHICINE 0.6 MG TA .6MG/1TAB
|
Facility
|
OP
|
$24.19
|
|
|
Service Code
|
NDC 64764011907
|
| Hospital Charge Code |
25000444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$23.22 |
| Rate for Payer: Aetna Commercial |
$18.63
|
| Rate for Payer: Anthem Medicaid |
$8.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.87
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cigna Commercial |
$20.08
|
| Rate for Payer: First Health Commercial |
$22.98
|
| Rate for Payer: Humana Commercial |
$20.56
|
| Rate for Payer: Humana KY Medicaid |
$8.32
|
| Rate for Payer: Kentucky WC Medicaid |
$8.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.29
|
| Rate for Payer: Ohio Health Group HMO |
$18.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.69
|
| Rate for Payer: PHCS Commercial |
$23.22
|
| Rate for Payer: United Healthcare All Payer |
$21.29
|
|
|
COLCHICINE 0.6 MG TA .6MG/1TAB
|
Facility
|
IP
|
$24.19
|
|
|
Service Code
|
NDC 64764011907
|
| Hospital Charge Code |
25000444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$23.22 |
| Rate for Payer: Aetna Commercial |
$18.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.87
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cigna Commercial |
$20.08
|
| Rate for Payer: First Health Commercial |
$22.98
|
| Rate for Payer: Humana Commercial |
$20.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.29
|
| Rate for Payer: Ohio Health Group HMO |
$18.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.69
|
| Rate for Payer: PHCS Commercial |
$23.22
|
| Rate for Payer: United Healthcare All Payer |
$21.29
|
|
|
COLD KNIFE CONE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
76102203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
COLD KNIFE CONE
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
76102203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.31 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$410.56
|
| Rate for Payer: Ambetter Exchange |
$279.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.31
|
| Rate for Payer: Anthem Medicaid |
$226.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$279.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$279.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$335.36
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$406.91
|
| Rate for Payer: Healthspan PPO |
$444.17
|
| Rate for Payer: Humana Medicaid |
$226.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$351.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$279.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.00
|
| Rate for Payer: Molina Healthcare Passport |
$226.47
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$363.31
|
| Rate for Payer: UHCCP Medicaid |
$194.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$228.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$279.47
|
|
|
COLD KNIFE CONE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
76102203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
COLD KNIFE CONE(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
761P2203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.31 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$410.56
|
| Rate for Payer: Ambetter Exchange |
$279.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.31
|
| Rate for Payer: Anthem Medicaid |
$226.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$279.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$279.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$335.36
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$406.91
|
| Rate for Payer: Healthspan PPO |
$444.17
|
| Rate for Payer: Humana Medicaid |
$226.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$351.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$279.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.00
|
| Rate for Payer: Molina Healthcare Passport |
$226.47
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$363.31
|
| Rate for Payer: UHCCP Medicaid |
$194.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$228.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$279.47
|
|
|
COLECTOMY - PARTIAL; ABDOMINA
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44147
|
| Hospital Charge Code |
76101820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem Medicaid |
$1,048.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Humana KY Medicaid |
$1,048.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,059.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,069.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
COLECTOMY - PARTIAL; ABDOMINA
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44147
|
| Hospital Charge Code |
76101820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$967.88 |
| Max. Negotiated Rate |
$2,692.93 |
| Rate for Payer: Aetna Commercial |
$2,692.93
|
| Rate for Payer: Ambetter Exchange |
$1,836.75
|
| Rate for Payer: Anthem Medicaid |
$967.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,836.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,836.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,204.10
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,438.09
|
| Rate for Payer: Healthspan PPO |
$2,271.00
|
| Rate for Payer: Humana Medicaid |
$967.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,466.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,836.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,836.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$987.24
|
| Rate for Payer: Molina Healthcare Passport |
$967.88
|
| Rate for Payer: Multiplan PHCS |
$1,830.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,387.78
|
| Rate for Payer: UHCCP Medicaid |
$1,067.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$977.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,836.75
|
|
|
COLECTOMY - PARTIAL; ABDOMINA
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44147
|
| Hospital Charge Code |
76101820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
COLECTOMY - PARTIAL; ABDOMIN(P
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44147
|
| Hospital Charge Code |
761P1820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$967.88 |
| Max. Negotiated Rate |
$2,692.93 |
| Rate for Payer: Aetna Commercial |
$2,692.93
|
| Rate for Payer: Ambetter Exchange |
$1,836.75
|
| Rate for Payer: Anthem Medicaid |
$967.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,836.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,836.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,204.10
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,438.09
|
| Rate for Payer: Healthspan PPO |
$2,271.00
|
| Rate for Payer: Humana Medicaid |
$967.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,466.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,836.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,836.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$987.24
|
| Rate for Payer: Molina Healthcare Passport |
$967.88
|
| Rate for Payer: Multiplan PHCS |
$1,830.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,387.78
|
| Rate for Payer: UHCCP Medicaid |
$1,067.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$977.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,836.75
|
|
|
COLECTOMY - PARTIAL; WITH ANA
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 44140
|
| Hospital Charge Code |
76101814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,044.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
COLECTOMY - PARTIAL; WITH ANA
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 44140
|
| Hospital Charge Code |
76101814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem Medicaid |
$808.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Humana KY Medicaid |
$808.16
|
| Rate for Payer: Kentucky WC Medicaid |
$816.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$824.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,044.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
COLECTOMY - PARTIAL; WITH ANA
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 44140
|
| Hospital Charge Code |
76101814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.50 |
| Max. Negotiated Rate |
$1,944.45 |
| Rate for Payer: Aetna Commercial |
$1,944.45
|
| Rate for Payer: Ambetter Exchange |
$1,275.73
|
| Rate for Payer: Anthem Medicaid |
$920.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,275.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,275.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,530.88
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,816.00
|
| Rate for Payer: Healthspan PPO |
$1,639.79
|
| Rate for Payer: Humana Medicaid |
$920.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,712.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,275.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$938.47
|
| Rate for Payer: Molina Healthcare Passport |
$920.07
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,658.45
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$929.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,275.73
|
|
|
COLECTOMY - PARTIAL; WITH AN(P
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 44140
|
| Hospital Charge Code |
761P1814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.50 |
| Max. Negotiated Rate |
$1,944.45 |
| Rate for Payer: Aetna Commercial |
$1,944.45
|
| Rate for Payer: Ambetter Exchange |
$1,275.73
|
| Rate for Payer: Anthem Medicaid |
$920.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,275.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,275.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,530.88
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,816.00
|
| Rate for Payer: Healthspan PPO |
$1,639.79
|
| Rate for Payer: Humana Medicaid |
$920.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,712.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,275.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$938.47
|
| Rate for Payer: Molina Healthcare Passport |
$920.07
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,658.45
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$929.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,275.73
|
|
|
COLECTOMY - PARTIAL; WITH COL
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 44146
|
| Hospital Charge Code |
76101819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
COLECTOMY - PARTIAL; WITH COL
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 44146
|
| Hospital Charge Code |
76101819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$3,001.97 |
| Rate for Payer: Aetna Commercial |
$3,001.97
|
| Rate for Payer: Ambetter Exchange |
$1,982.24
|
| Rate for Payer: Anthem Medicaid |
$1,130.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,982.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,982.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,378.69
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,775.21
|
| Rate for Payer: Healthspan PPO |
$2,531.61
|
| Rate for Payer: Humana Medicaid |
$1,130.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,687.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,982.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,982.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,152.71
|
| Rate for Payer: Molina Healthcare Passport |
$1,130.11
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,576.91
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,141.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,982.24
|
|
|
COLECTOMY - PARTIAL; WITH COL
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 44146
|
| Hospital Charge Code |
76101819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
COLECTOMY - PARTIAL; WITH CO(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 44146
|
| Hospital Charge Code |
761P1819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$3,001.97 |
| Rate for Payer: Aetna Commercial |
$3,001.97
|
| Rate for Payer: Ambetter Exchange |
$1,982.24
|
| Rate for Payer: Anthem Medicaid |
$1,130.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,982.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,982.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,378.69
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,775.21
|
| Rate for Payer: Healthspan PPO |
$2,531.61
|
| Rate for Payer: Humana Medicaid |
$1,130.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,687.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,982.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,982.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,152.71
|
| Rate for Payer: Molina Healthcare Passport |
$1,130.11
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,576.91
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,141.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,982.24
|
|
|
COLECTOMY - PARTIAL; WITH END
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 44143
|
| Hospital Charge Code |
76101816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem Medicaid |
$825.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Humana KY Medicaid |
$825.36
|
| Rate for Payer: Kentucky WC Medicaid |
$833.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$841.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
COLECTOMY - PARTIAL; WITH END
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 44143
|
| Hospital Charge Code |
76101816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$832.65 |
| Max. Negotiated Rate |
$2,385.94 |
| Rate for Payer: Aetna Commercial |
$2,385.94
|
| Rate for Payer: Ambetter Exchange |
$1,564.22
|
| Rate for Payer: Anthem Medicaid |
$832.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,564.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,564.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,877.06
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$2,224.50
|
| Rate for Payer: Healthspan PPO |
$2,012.11
|
| Rate for Payer: Humana Medicaid |
$832.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,123.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,564.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,564.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$849.30
|
| Rate for Payer: Molina Healthcare Passport |
$832.65
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,033.49
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$840.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,564.22
|
|
|
COLECTOMY - PARTIAL; WITH END
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 44143
|
| Hospital Charge Code |
76101816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
COLECTOMY - PARTIAL; WITH EN(P
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 44143
|
| Hospital Charge Code |
761P1816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$832.65 |
| Max. Negotiated Rate |
$2,385.94 |
| Rate for Payer: Aetna Commercial |
$2,385.94
|
| Rate for Payer: Ambetter Exchange |
$1,564.22
|
| Rate for Payer: Anthem Medicaid |
$832.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,564.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,564.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,877.06
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$2,224.50
|
| Rate for Payer: Healthspan PPO |
$2,012.11
|
| Rate for Payer: Humana Medicaid |
$832.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,123.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,564.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,564.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$849.30
|
| Rate for Payer: Molina Healthcare Passport |
$832.65
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,033.49
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$840.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,564.22
|
|
