|
COLECTOMY - PARTIAL; WITH SKI
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 44141
|
| Hospital Charge Code |
76101815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
COLECTOMY - PARTIAL; WITH SKI
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 44141
|
| Hospital Charge Code |
76101815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
COLECTOMY - PARTIAL; WITH SKI
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 44141
|
| Hospital Charge Code |
76101815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$889.47 |
| Max. Negotiated Rate |
$2,524.88 |
| Rate for Payer: Aetna Commercial |
$2,524.88
|
| Rate for Payer: Ambetter Exchange |
$1,712.66
|
| Rate for Payer: Anthem Medicaid |
$889.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,712.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,712.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,055.19
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,302.85
|
| Rate for Payer: Healthspan PPO |
$2,129.27
|
| Rate for Payer: Humana Medicaid |
$889.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,310.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,712.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,712.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$907.26
|
| Rate for Payer: Molina Healthcare Passport |
$889.47
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,226.46
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$898.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,712.66
|
|
|
COLECTOMY - PARTIAL; WITH SK(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 44141
|
| Hospital Charge Code |
761P1815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$889.47 |
| Max. Negotiated Rate |
$2,524.88 |
| Rate for Payer: Aetna Commercial |
$2,524.88
|
| Rate for Payer: Ambetter Exchange |
$1,712.66
|
| Rate for Payer: Anthem Medicaid |
$889.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,712.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,712.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,055.19
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,302.85
|
| Rate for Payer: Healthspan PPO |
$2,129.27
|
| Rate for Payer: Humana Medicaid |
$889.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,310.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,712.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,712.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$907.26
|
| Rate for Payer: Molina Healthcare Passport |
$889.47
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,226.46
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$898.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,712.66
|
|
|
COLECTOMY TOTAL
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
HCPCS 44151
|
| Hospital Charge Code |
76101822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
COLECTOMY TOTAL
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
HCPCS 44151
|
| Hospital Charge Code |
76101822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem Medicaid |
$1,152.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Humana KY Medicaid |
$1,152.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,163.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,175.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
COLECTOMY TOTAL
|
Professional
|
Both
|
$3,350.00
|
|
|
Service Code
|
HCPCS 44151
|
| Hospital Charge Code |
76101822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$854.51 |
| Max. Negotiated Rate |
$3,010.76 |
| Rate for Payer: Aetna Commercial |
$3,010.76
|
| Rate for Payer: Ambetter Exchange |
$2,035.98
|
| Rate for Payer: Anthem Medicaid |
$854.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,035.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,035.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,443.18
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,790.48
|
| Rate for Payer: Healthspan PPO |
$2,539.03
|
| Rate for Payer: Humana Medicaid |
$854.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,723.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,035.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,035.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$871.60
|
| Rate for Payer: Molina Healthcare Passport |
$854.51
|
| Rate for Payer: Multiplan PHCS |
$2,010.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,646.77
|
| Rate for Payer: UHCCP Medicaid |
$1,172.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$863.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,035.98
|
|
|
COLECTOMY TOTAL(P
|
Professional
|
Both
|
$3,350.00
|
|
|
Service Code
|
HCPCS 44151
|
| Hospital Charge Code |
761P1822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$854.51 |
| Max. Negotiated Rate |
$3,010.76 |
| Rate for Payer: Aetna Commercial |
$3,010.76
|
| Rate for Payer: Ambetter Exchange |
$2,035.98
|
| Rate for Payer: Anthem Medicaid |
$854.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,035.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,035.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,443.18
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,790.48
|
| Rate for Payer: Healthspan PPO |
$2,539.03
|
| Rate for Payer: Humana Medicaid |
$854.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,723.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,035.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,035.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$871.60
|
| Rate for Payer: Molina Healthcare Passport |
$854.51
|
| Rate for Payer: Multiplan PHCS |
$2,010.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,646.77
|
| Rate for Payer: UHCCP Medicaid |
$1,172.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$863.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,035.98
|
|
|
COLECTOMY TOTAL W ILEOSTOMY
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44150
|
| Hospital Charge Code |
76101821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,033.77 |
| Max. Negotiated Rate |
$2,631.75 |
| Rate for Payer: Aetna Commercial |
$2,631.75
|
| Rate for Payer: Ambetter Exchange |
$1,749.70
|
| Rate for Payer: Anthem Medicaid |
$1,033.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,749.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,749.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,099.64
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,436.77
|
| Rate for Payer: Healthspan PPO |
$2,219.40
|
| Rate for Payer: Humana Medicaid |
$1,033.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,370.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,749.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,749.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,054.45
|
| Rate for Payer: Molina Healthcare Passport |
$1,033.77
|
| Rate for Payer: Multiplan PHCS |
$1,830.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,274.61
|
| Rate for Payer: UHCCP Medicaid |
$1,067.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,044.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,749.70
|
|
|
COLECTOMY TOTAL W ILEOSTOMY
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44150
|
| Hospital Charge Code |
76101821
|
|
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 TOTAL W ILEOSTOMY
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44150
|
| Hospital Charge Code |
76101821
|
|
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 TOTAL W ILEOSTOMY(P
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44150
|
| Hospital Charge Code |
761P1821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,033.77 |
| Max. Negotiated Rate |
$2,631.75 |
| Rate for Payer: Aetna Commercial |
$2,631.75
|
| Rate for Payer: Ambetter Exchange |
$1,749.70
|
| Rate for Payer: Anthem Medicaid |
$1,033.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,749.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,749.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,099.64
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,436.77
|
| Rate for Payer: Healthspan PPO |
$2,219.40
|
| Rate for Payer: Humana Medicaid |
$1,033.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,370.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,749.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,749.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,054.45
|
| Rate for Payer: Molina Healthcare Passport |
$1,033.77
|
| Rate for Payer: Multiplan PHCS |
$1,830.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,274.61
|
| Rate for Payer: UHCCP Medicaid |
$1,067.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,044.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,749.70
|
|
|
COLESTID(COLESTIPOL) 1GRAM TAB
|
Facility
|
OP
|
$9.05
|
|
|
Service Code
|
NDC 59762045001
|
| Hospital Charge Code |
25000445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: Aetna Commercial |
$6.97
|
| Rate for Payer: Anthem Medicaid |
$3.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.06
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna Commercial |
$7.51
|
| Rate for Payer: First Health Commercial |
$8.60
|
| Rate for Payer: Humana Commercial |
$7.69
|
| Rate for Payer: Humana KY Medicaid |
$3.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.96
|
| Rate for Payer: Ohio Health Group HMO |
$6.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.24
|
| Rate for Payer: PHCS Commercial |
$8.69
|
| Rate for Payer: United Healthcare All Payer |
$7.96
|
|
|
COLESTID(COLESTIPOL) 1GRAM TAB
|
Facility
|
IP
|
$9.05
|
|
|
Service Code
|
NDC 59762045001
|
| Hospital Charge Code |
25000445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: Aetna Commercial |
$6.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.06
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna Commercial |
$7.51
|
| Rate for Payer: First Health Commercial |
$8.60
|
| Rate for Payer: Humana Commercial |
$7.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.96
|
| Rate for Payer: Ohio Health Group HMO |
$6.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.24
|
| Rate for Payer: PHCS Commercial |
$8.69
|
| Rate for Payer: United Healthcare All Payer |
$7.96
|
|
|
COLISTIMETHATE SOD 150MG/2ML
|
Facility
|
OP
|
$183.99
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
25001967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$176.63 |
| Rate for Payer: Aetna Commercial |
$141.67
|
| Rate for Payer: Anthem Medicaid |
$63.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.51
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.71
|
| Rate for Payer: First Health Commercial |
$174.79
|
| Rate for Payer: Humana Commercial |
$156.39
|
| Rate for Payer: Humana KY Medicaid |
$63.27
|
| Rate for Payer: Kentucky WC Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.91
|
| Rate for Payer: Ohio Health Group HMO |
$137.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.95
|
| Rate for Payer: PHCS Commercial |
$176.63
|
| Rate for Payer: United Healthcare All Payer |
$161.91
|
|
|
COLISTIMETHATE SOD 150MG/2ML
|
Facility
|
IP
|
$183.99
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
25001967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$176.63 |
| Rate for Payer: Aetna Commercial |
$141.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.51
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.71
|
| Rate for Payer: First Health Commercial |
$174.79
|
| Rate for Payer: Humana Commercial |
$156.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.91
|
| Rate for Payer: Ohio Health Group HMO |
$137.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.95
|
| Rate for Payer: PHCS Commercial |
$176.63
|
| Rate for Payer: United Healthcare All Payer |
$161.91
|
|
|
COLLECT BLD VASCULAR ACCESS
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
30000003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$119.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.10
|
| 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 |
$119.10
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$120.29
|
| 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 |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.48
|
| 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
|
|
|
COLLECT BLD VASCULAR ACCESS
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
30000003
|
|
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
|
|
|
COLLECT CAPILLARY BLOOD SPEC
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.44
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.97
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
COLLECT CAPILLARY BLOOD SPEC
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$4.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.44
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Humana KY Medicaid |
$4.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.97
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
COLLECT CAPILLARY BLOOD SPEC
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Anthem Medicaid |
$3.27
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$4.96
|
| Rate for Payer: Healthspan PPO |
$3.84
|
| Rate for Payer: Humana Medicaid |
$3.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3.34
|
| Rate for Payer: Molina Healthcare Passport |
$3.27
|
| Rate for Payer: Multiplan PHCS |
$7.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.10
|
| Rate for Payer: UHCCP Medicaid |
$4.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.30
|
|
|
COLONOS CECUM POLYPECT
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
76101896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
COLONOS CECUM POLYPECT
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
76101896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.70 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$412.88
|
| Rate for Payer: Ambetter Exchange |
$213.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$231.86
|
| Rate for Payer: Anthem Medicaid |
$467.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$213.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$213.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$256.44
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$377.11
|
| Rate for Payer: Healthspan PPO |
$567.09
|
| Rate for Payer: Humana Medicaid |
$467.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$354.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$213.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$477.13
|
| Rate for Payer: Molina Healthcare Passport |
$467.77
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$277.81
|
| Rate for Payer: UHCCP Medicaid |
$243.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$472.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$213.70
|
|
|
COLONOS CECUM POLYPECT
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
76101896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
COLONOS CECUM POLYPECT(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
761P1896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.70 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$412.88
|
| Rate for Payer: Ambetter Exchange |
$213.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$231.86
|
| Rate for Payer: Anthem Medicaid |
$467.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$213.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$213.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$256.44
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$377.11
|
| Rate for Payer: Healthspan PPO |
$567.09
|
| Rate for Payer: Humana Medicaid |
$467.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$354.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$213.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$477.13
|
| Rate for Payer: Molina Healthcare Passport |
$467.77
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$277.81
|
| Rate for Payer: UHCCP Medicaid |
$243.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$472.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$213.70
|
|
