|
ENTERECTOMY - RESECTION OF SM
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44120
|
| Hospital Charge Code |
76101810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
ENTERECTOMY - RESECTION OF SM
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44120
|
| Hospital Charge Code |
76101810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$688.69 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,753.55
|
| Rate for Payer: Anthem Medicaid |
$688.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,620.66
|
| Rate for Payer: Healthspan PPO |
$1,478.80
|
| Rate for Payer: Humana Medicaid |
$688.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,560.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$702.46
|
| Rate for Payer: Molina Healthcare Passport |
$688.69
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$695.58
|
|
|
ENTERECTOMY - RESECTION OF SM
|
Facility
|
IP
|
$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 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 |
$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
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44120
|
| Hospital Charge Code |
76101810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
ENTERECTOMY - RESECTION OF S(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 44121
|
| Hospital Charge Code |
761P1811
|
|
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
|
|
|
ENTERECTOMY - RESECTION OF S(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44120
|
| Hospital Charge Code |
761P1810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$688.69 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,753.55
|
| Rate for Payer: Anthem Medicaid |
$688.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,620.66
|
| Rate for Payer: Healthspan PPO |
$1,478.80
|
| Rate for Payer: Humana Medicaid |
$688.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,560.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$702.46
|
| Rate for Payer: Molina Healthcare Passport |
$688.69
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$695.58
|
|
|
ENTEREG 12MG CAPSULE
|
Facility
|
IP
|
$327.11
|
|
|
Service Code
|
NDC 254301255
|
| Hospital Charge Code |
25000622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$314.03 |
| Rate for Payer: Aetna Commercial |
$251.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.15
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Cigna Commercial |
$271.50
|
| Rate for Payer: First Health Commercial |
$310.75
|
| Rate for Payer: Humana Commercial |
$278.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.86
|
| Rate for Payer: Ohio Health Group HMO |
$245.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.40
|
| Rate for Payer: PHCS Commercial |
$314.03
|
| Rate for Payer: United Healthcare All Payer |
$287.86
|
|
|
ENTEREG 12MG CAPSULE
|
Facility
|
OP
|
$327.11
|
|
|
Service Code
|
NDC 254301255
|
| Hospital Charge Code |
25000622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$314.03 |
| Rate for Payer: Aetna Commercial |
$251.87
|
| Rate for Payer: Anthem Medicaid |
$112.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.15
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Cigna Commercial |
$271.50
|
| Rate for Payer: First Health Commercial |
$310.75
|
| Rate for Payer: Humana Commercial |
$278.04
|
| Rate for Payer: Humana KY Medicaid |
$112.49
|
| Rate for Payer: Kentucky WC Medicaid |
$113.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.86
|
| Rate for Payer: Ohio Health Group HMO |
$245.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.40
|
| Rate for Payer: PHCS Commercial |
$314.03
|
| Rate for Payer: United Healthcare All Payer |
$287.86
|
|
|
ENTERIC PATHOGEN MOLECULAR PAN
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
HCPCS 87506
|
| Hospital Charge Code |
30001373
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$745.92 |
| Rate for Payer: Aetna Commercial |
$598.29
|
| Rate for Payer: Anthem Medicaid |
$262.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$262.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$368.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.99
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$644.91
|
| Rate for Payer: First Health Commercial |
$738.15
|
| Rate for Payer: Humana Commercial |
$660.45
|
| Rate for Payer: Humana KY Medicaid |
$262.99
|
| Rate for Payer: Humana Medicare Advantage |
$262.99
|
| Rate for Payer: Kentucky WC Medicaid |
$265.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$573.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$268.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$683.76
|
| Rate for Payer: Ohio Health Group HMO |
$582.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.87
|
| Rate for Payer: PHCS Commercial |
$745.92
|
| Rate for Payer: United Healthcare All Payer |
$683.76
|
|
|
ENTERIC PATHOGEN MOLECULAR PAN
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
HCPCS 87506
|
| Hospital Charge Code |
30001373
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$745.92 |
| Rate for Payer: Aetna Commercial |
$598.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.93
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$644.91
|
| Rate for Payer: First Health Commercial |
$738.15
|
| Rate for Payer: Humana Commercial |
$660.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$573.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$683.76
|
| Rate for Payer: Ohio Health Group HMO |
$582.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.87
|
| Rate for Payer: PHCS Commercial |
$745.92
|
| Rate for Payer: United Healthcare All Payer |
$683.76
|
|
|
ENTEROBACTER GYRB METB GENES
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001311
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
ENTEROBACTER GYRB METB GENES
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001311
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
ENTEROSTOMY OR CECOSTOMY - T(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44300
|
| Hospital Charge Code |
761P1835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.08 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$1,206.99
|
| Rate for Payer: Anthem Medicaid |
$421.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,119.52
|
| Rate for Payer: Healthspan PPO |
$1,017.87
|
| Rate for Payer: Humana Medicaid |
$421.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,073.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$429.50
|
| Rate for Payer: Molina Healthcare Passport |
$421.08
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.29
|
|
|
ENTEROSTOMY OR CECOSTOMY - TU
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44300
|
| Hospital Charge Code |
76101835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Humana KY Medicaid |
$429.88
|
| Rate for Payer: Kentucky WC Medicaid |
$434.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
ENTEROSTOMY OR CECOSTOMY - TU
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44300
|
| Hospital Charge Code |
76101835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
ENTEROSTOMY OR CECOSTOMY - TU
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44300
|
| Hospital Charge Code |
76101835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.08 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$1,206.99
|
| Rate for Payer: Anthem Medicaid |
$421.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,119.52
|
| Rate for Payer: Healthspan PPO |
$1,017.87
|
| Rate for Payer: Humana Medicaid |
$421.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,073.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$429.50
|
| Rate for Payer: Molina Healthcare Passport |
$421.08
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.29
|
|
|
ENTERSCPY > 2PRTN W/CONT BLEED
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 44366
|
| Hospital Charge Code |
76101845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.25 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.75
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
ENTERSCPY > 2PRTN W/CONT BLEED
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 44366
|
| Hospital Charge Code |
761P1845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$1,225.00 |
| Rate for Payer: Aetna Commercial |
$398.30
|
| Rate for Payer: Anthem Medicaid |
$313.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,225.00
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$356.70
|
| Rate for Payer: Healthspan PPO |
$335.89
|
| Rate for Payer: Humana Medicaid |
$313.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$340.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$320.23
|
| Rate for Payer: Molina Healthcare Passport |
$313.95
|
| Rate for Payer: Multiplan PHCS |
$735.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$857.50
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$317.09
|
|
|
ENTERSCPY > 2PRTN W/CONT BLEED
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 44366
|
| Hospital Charge Code |
76101845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.25 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem Medicaid |
$421.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Humana KY Medicaid |
$421.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$425.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$429.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.75
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
ENTERSCPY > 2PRTN W/CONT BLEED
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 44366
|
| Hospital Charge Code |
76101845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$1,225.00 |
| Rate for Payer: Aetna Commercial |
$398.30
|
| Rate for Payer: Anthem Medicaid |
$313.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,225.00
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$356.70
|
| Rate for Payer: Healthspan PPO |
$335.89
|
| Rate for Payer: Humana Medicaid |
$313.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$340.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$320.23
|
| Rate for Payer: Molina Healthcare Passport |
$313.95
|
| Rate for Payer: Multiplan PHCS |
$735.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$857.50
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$317.09
|
|
|
ENTERSCPY > 2PRTN W/PLMT PTUBE
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 44372
|
| Hospital Charge Code |
761P1846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.49 |
| Max. Negotiated Rate |
$1,185.00 |
| Rate for Payer: Aetna Commercial |
$389.19
|
| Rate for Payer: Anthem Medicaid |
$318.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,185.00
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$355.10
|
| Rate for Payer: Healthspan PPO |
$328.21
|
| Rate for Payer: Humana Medicaid |
$318.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$335.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$324.86
|
| Rate for Payer: Molina Healthcare Passport |
$318.49
|
| Rate for Payer: Multiplan PHCS |
$711.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$829.50
|
| Rate for Payer: UHCCP Medicaid |
$414.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.67
|
|
|
ENTERSCPY > 2PRTN W/PLMT PTUBE
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
HCPCS 44372
|
| Hospital Charge Code |
76101846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.05 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Aetna Commercial |
$912.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.30
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$983.55
|
| Rate for Payer: First Health Commercial |
$1,125.75
|
| Rate for Payer: Humana Commercial |
$1,007.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$355.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.80
|
| Rate for Payer: Ohio Health Group HMO |
$888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$367.35
|
| Rate for Payer: PHCS Commercial |
$1,137.60
|
| Rate for Payer: United Healthcare All Payer |
$1,042.80
|
|
|
ENTERSCPY > 2PRTN W/PLMT PTUBE
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 44372
|
| Hospital Charge Code |
76101846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.49 |
| Max. Negotiated Rate |
$1,185.00 |
| Rate for Payer: Aetna Commercial |
$389.19
|
| Rate for Payer: Anthem Medicaid |
$318.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,185.00
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$355.10
|
| Rate for Payer: Healthspan PPO |
$328.21
|
| Rate for Payer: Humana Medicaid |
$318.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$335.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$324.86
|
| Rate for Payer: Molina Healthcare Passport |
$318.49
|
| Rate for Payer: Multiplan PHCS |
$711.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$829.50
|
| Rate for Payer: UHCCP Medicaid |
$414.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.67
|
|
|
ENTERSCPY > 2PRTN W/PLMT PTUBE
|
Facility
|
OP
|
$1,185.00
|
|
|
Service Code
|
HCPCS 44372
|
| Hospital Charge Code |
76101846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.05 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$912.45
|
| Rate for Payer: Anthem Medicaid |
$407.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$983.55
|
| Rate for Payer: First Health Commercial |
$1,125.75
|
| Rate for Payer: Humana Commercial |
$1,007.25
|
| Rate for Payer: Humana KY Medicaid |
$407.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$411.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$415.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.80
|
| Rate for Payer: Ohio Health Group HMO |
$888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$367.35
|
| Rate for Payer: PHCS Commercial |
$1,137.60
|
| Rate for Payer: United Healthcare All Payer |
$1,042.80
|
|
|
ENT FAECALIS HSP60 GENE
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
