|
ENO EXPIRED NITRIC OXIDE GAS(P
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 95012
|
| Hospital Charge Code |
460P0022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$24.72
|
| Rate for Payer: Anthem Medicaid |
$12.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$27.04
|
| Rate for Payer: Healthspan PPO |
$33.23
|
| Rate for Payer: Humana Medicaid |
$12.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.68
|
| Rate for Payer: Molina Healthcare Passport |
$12.43
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.55
|
|
|
ENO EXPIRED NITRIC OXIDE GAS(T
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 95012
|
| Hospital Charge Code |
460T0022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.86
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
ENO EXPIRED NITRIC OXIDE GAS(T
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 95012
|
| Hospital Charge Code |
460T0022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem Medicaid |
$64.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Humana KY Medicaid |
$64.31
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$64.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
ENSEAL 37CM CVD JAW
|
Facility
|
IP
|
$8,609.27
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,119.21 |
| Max. Negotiated Rate |
$8,264.90 |
| Rate for Payer: Aetna Commercial |
$6,629.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,715.23
|
| Rate for Payer: Cash Price |
$4,304.63
|
| Rate for Payer: Cigna Commercial |
$7,145.69
|
| Rate for Payer: First Health Commercial |
$8,178.81
|
| Rate for Payer: Humana Commercial |
$7,317.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,059.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,353.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,576.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,456.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.87
|
| Rate for Payer: PHCS Commercial |
$8,264.90
|
| Rate for Payer: United Healthcare All Payer |
$7,576.16
|
|
|
ENSEAL 37CM CVD JAW
|
Facility
|
OP
|
$8,609.27
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,119.21 |
| Max. Negotiated Rate |
$8,264.90 |
| Rate for Payer: Aetna Commercial |
$6,629.14
|
| Rate for Payer: Anthem Medicaid |
$2,960.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,715.23
|
| Rate for Payer: Cash Price |
$4,304.63
|
| Rate for Payer: Cigna Commercial |
$7,145.69
|
| Rate for Payer: First Health Commercial |
$8,178.81
|
| Rate for Payer: Humana Commercial |
$7,317.88
|
| Rate for Payer: Humana KY Medicaid |
$2,960.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,990.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,059.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,353.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,576.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,456.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.87
|
| Rate for Payer: PHCS Commercial |
$8,264.90
|
| Rate for Payer: United Healthcare All Payer |
$7,576.16
|
|
|
EN SNARE 12-20MM
|
Facility
|
OP
|
$3,358.50
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$3,224.16 |
| Rate for Payer: Aetna Commercial |
$2,586.04
|
| Rate for Payer: Anthem Medicaid |
$1,154.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,619.63
|
| Rate for Payer: Cash Price |
$1,679.25
|
| Rate for Payer: Cigna Commercial |
$2,787.56
|
| Rate for Payer: First Health Commercial |
$3,190.58
|
| Rate for Payer: Humana Commercial |
$2,854.72
|
| Rate for Payer: Humana KY Medicaid |
$1,154.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,166.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,753.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,478.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,178.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,955.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,518.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.14
|
| Rate for Payer: PHCS Commercial |
$3,224.16
|
| Rate for Payer: United Healthcare All Payer |
$2,955.48
|
|
|
EN SNARE 12-20MM
|
Facility
|
IP
|
$3,358.50
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$3,224.16 |
| Rate for Payer: Aetna Commercial |
$2,586.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,619.63
|
| Rate for Payer: Cash Price |
$1,679.25
|
| Rate for Payer: Cigna Commercial |
$2,787.56
|
| Rate for Payer: First Health Commercial |
$3,190.58
|
| Rate for Payer: Humana Commercial |
$2,854.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,753.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,478.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,955.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,518.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.14
|
| Rate for Payer: PHCS Commercial |
$3,224.16
|
| Rate for Payer: United Healthcare All Payer |
$2,955.48
|
|
|
EN SNARE 2-4MM
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$568.10 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,354.70
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
EN SNARE 2-4MM
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$568.10 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,354.70
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
EN SNARE 9-15MM
|
Facility
|
IP
|
$3,358.50
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$3,224.16 |
| Rate for Payer: Aetna Commercial |
$2,586.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,619.63
|
| Rate for Payer: Cash Price |
$1,679.25
|
| Rate for Payer: Cigna Commercial |
$2,787.56
|
| Rate for Payer: First Health Commercial |
$3,190.58
|
| Rate for Payer: Humana Commercial |
$2,854.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,753.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,478.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,955.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,518.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.14
|
| Rate for Payer: PHCS Commercial |
$3,224.16
|
| Rate for Payer: United Healthcare All Payer |
$2,955.48
|
|
|
EN SNARE 9-15MM
|
Facility
|
OP
|
$3,358.50
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$3,224.16 |
| Rate for Payer: Aetna Commercial |
$2,586.04
|
| Rate for Payer: Anthem Medicaid |
$1,154.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,619.63
|
| Rate for Payer: Cash Price |
$1,679.25
|
| Rate for Payer: Cigna Commercial |
$2,787.56
|
| Rate for Payer: First Health Commercial |
$3,190.58
|
| Rate for Payer: Humana Commercial |
$2,854.72
|
| Rate for Payer: Humana KY Medicaid |
$1,154.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,166.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,753.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,478.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,178.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,955.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,518.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.14
|
| Rate for Payer: PHCS Commercial |
$3,224.16
|
| Rate for Payer: United Healthcare All Payer |
$2,955.48
|
|
|
EN SNARE MINI 4-8
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$568.10 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,354.70
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
EN SNARE MINI 4-8
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$568.10 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,354.70
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
EN SNARE SYSTEM 30MM
|
Facility
|
IP
|
$3,358.50
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$3,224.16 |
| Rate for Payer: Aetna Commercial |
$2,586.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,619.63
|
| Rate for Payer: Cash Price |
$1,679.25
|
| Rate for Payer: Cigna Commercial |
$2,787.56
|
| Rate for Payer: First Health Commercial |
$3,190.58
|
| Rate for Payer: Humana Commercial |
$2,854.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,753.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,478.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,955.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,518.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.14
|
| Rate for Payer: PHCS Commercial |
$3,224.16
|
| Rate for Payer: United Healthcare All Payer |
$2,955.48
|
|
|
EN SNARE SYSTEM 30MM
|
Facility
|
OP
|
$3,358.50
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$3,224.16 |
| Rate for Payer: Aetna Commercial |
$2,586.04
|
| Rate for Payer: Anthem Medicaid |
$1,154.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,619.63
|
| Rate for Payer: Cash Price |
$1,679.25
|
| Rate for Payer: Cigna Commercial |
$2,787.56
|
| Rate for Payer: First Health Commercial |
$3,190.58
|
| Rate for Payer: Humana Commercial |
$2,854.72
|
| Rate for Payer: Humana KY Medicaid |
$1,154.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,166.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,753.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,478.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,178.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,955.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,518.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.14
|
| Rate for Payer: PHCS Commercial |
$3,224.16
|
| Rate for Payer: United Healthcare All Payer |
$2,955.48
|
|
|
EN SNARE SYSTEM 45MM
|
Facility
|
IP
|
$3,358.50
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$3,224.16 |
| Rate for Payer: Aetna Commercial |
$2,586.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,619.63
|
| Rate for Payer: Cash Price |
$1,679.25
|
| Rate for Payer: Cigna Commercial |
$2,787.56
|
| Rate for Payer: First Health Commercial |
$3,190.58
|
| Rate for Payer: Humana Commercial |
$2,854.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,753.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,478.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,955.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,518.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.14
|
| Rate for Payer: PHCS Commercial |
$3,224.16
|
| Rate for Payer: United Healthcare All Payer |
$2,955.48
|
|
|
EN SNARE SYSTEM 45MM
|
Facility
|
OP
|
$3,358.50
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27000250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$3,224.16 |
| Rate for Payer: Aetna Commercial |
$2,586.04
|
| Rate for Payer: Anthem Medicaid |
$1,154.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,619.63
|
| Rate for Payer: Cash Price |
$1,679.25
|
| Rate for Payer: Cigna Commercial |
$2,787.56
|
| Rate for Payer: First Health Commercial |
$3,190.58
|
| Rate for Payer: Humana Commercial |
$2,854.72
|
| Rate for Payer: Humana KY Medicaid |
$1,154.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,166.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,753.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,478.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,178.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,955.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,518.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.14
|
| Rate for Payer: PHCS Commercial |
$3,224.16
|
| Rate for Payer: United Healthcare All Payer |
$2,955.48
|
|
|
ENSURE LIQUID 237ML
|
Facility
|
OP
|
$66.06
|
|
|
Service Code
|
NDC 70074040711
|
| Hospital Charge Code |
25003848
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$63.42 |
| Rate for Payer: Aetna Commercial |
$50.87
|
| Rate for Payer: Anthem Medicaid |
$22.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.53
|
| Rate for Payer: Cash Price |
$33.03
|
| Rate for Payer: Cigna Commercial |
$54.83
|
| Rate for Payer: First Health Commercial |
$62.76
|
| Rate for Payer: Humana Commercial |
$56.15
|
| Rate for Payer: Humana KY Medicaid |
$22.72
|
| Rate for Payer: Kentucky WC Medicaid |
$22.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.13
|
| Rate for Payer: Ohio Health Group HMO |
$49.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.48
|
| Rate for Payer: PHCS Commercial |
$63.42
|
| Rate for Payer: United Healthcare All Payer |
$58.13
|
|
|
ENSURE LIQUID 237ML
|
Facility
|
IP
|
$66.06
|
|
|
Service Code
|
NDC 70074040711
|
| Hospital Charge Code |
25003848
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$63.42 |
| Rate for Payer: Aetna Commercial |
$50.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.53
|
| Rate for Payer: Cash Price |
$33.03
|
| Rate for Payer: Cigna Commercial |
$54.83
|
| Rate for Payer: First Health Commercial |
$62.76
|
| Rate for Payer: Humana Commercial |
$56.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.13
|
| Rate for Payer: Ohio Health Group HMO |
$49.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.48
|
| Rate for Payer: PHCS Commercial |
$63.42
|
| Rate for Payer: United Healthcare All Payer |
$58.13
|
|
|
ENSURE LIQUID 237ML
|
Facility
|
OP
|
$9.75
|
|
|
Service Code
|
NDC 70074056016
|
| Hospital Charge Code |
25003848
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Anthem Medicaid |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.60
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cigna Commercial |
$8.09
|
| Rate for Payer: First Health Commercial |
$9.26
|
| Rate for Payer: Humana Commercial |
$8.29
|
| Rate for Payer: Humana KY Medicaid |
$3.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.58
|
| Rate for Payer: Ohio Health Group HMO |
$7.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$9.36
|
| Rate for Payer: United Healthcare All Payer |
$8.58
|
|
|
ENSURE LIQUID 237ML
|
Facility
|
IP
|
$9.75
|
|
|
Service Code
|
NDC 70074056016
|
| Hospital Charge Code |
25003848
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.60
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cigna Commercial |
$8.09
|
| Rate for Payer: First Health Commercial |
$9.26
|
| Rate for Payer: Humana Commercial |
$8.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.58
|
| Rate for Payer: Ohio Health Group HMO |
$7.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$9.36
|
| Rate for Payer: United Healthcare All Payer |
$8.58
|
|
|
ENSURE PRE SURGERY LIQUID
|
Facility
|
OP
|
$10.65
|
|
|
Service Code
|
NDC 70074065044
|
| Hospital Charge Code |
25003039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Kentucky WC Medicaid |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.37
|
| Rate for Payer: Ohio Health Group HMO |
$7.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.30
|
| Rate for Payer: PHCS Commercial |
$10.22
|
| Rate for Payer: United Healthcare All Payer |
$9.37
|
| Rate for Payer: Aetna Commercial |
$8.20
|
| Rate for Payer: Anthem Medicaid |
$3.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.31
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Cigna Commercial |
$8.84
|
| Rate for Payer: First Health Commercial |
$10.12
|
| Rate for Payer: Humana Commercial |
$9.05
|
| Rate for Payer: Humana KY Medicaid |
$3.66
|
|
|
ENSURE PRE SURGERY LIQUID
|
Facility
|
IP
|
$10.65
|
|
|
Service Code
|
NDC 70074065044
|
| Hospital Charge Code |
25003039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna Commercial |
$8.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.31
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Cigna Commercial |
$8.84
|
| Rate for Payer: First Health Commercial |
$10.12
|
| Rate for Payer: Humana Commercial |
$9.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.37
|
| Rate for Payer: Ohio Health Group HMO |
$7.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.30
|
| Rate for Payer: PHCS Commercial |
$10.22
|
| Rate for Payer: United Healthcare All Payer |
$9.37
|
|
|
ENTERECTOMY - RESECTION OF SM
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 44121
|
| Hospital Charge Code |
76101811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| 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: Humana KY Medicaid |
$343.90
|
| 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 |
$300.00
|
| 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 |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
ENTERECTOMY - RESECTION OF SM
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 44121
|
| Hospital Charge Code |
76101811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.93 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$366.11
|
| Rate for Payer: Anthem Medicaid |
$205.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$347.30
|
| Rate for Payer: Healthspan PPO |
$308.74
|
| Rate for Payer: Humana Medicaid |
$205.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$313.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.05
|
| Rate for Payer: Molina Healthcare Passport |
$205.93
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$207.99
|
|
