|
ENT FAECALIS HSP60 GENE
|
Facility
|
OP
|
$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 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
|
|
|
ENT FAECLUM HSP60 GENE
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001297
|
|
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
|
|
|
ENT FAECLUM HSP60 GENE
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001297
|
|
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
|
|
|
ENTOCORT EC(BUDESONIDE)3MG CAP
|
Facility
|
OP
|
$12.45
|
|
|
Service Code
|
NDC 378715501
|
| Hospital Charge Code |
25000623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$11.95 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Anthem Medicaid |
$4.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.71
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cigna Commercial |
$10.33
|
| Rate for Payer: First Health Commercial |
$11.83
|
| Rate for Payer: Humana Commercial |
$10.58
|
| Rate for Payer: Humana KY Medicaid |
$4.28
|
| Rate for Payer: Kentucky WC Medicaid |
$4.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.96
|
| Rate for Payer: Ohio Health Group HMO |
$9.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.86
|
| Rate for Payer: PHCS Commercial |
$11.95
|
| Rate for Payer: United Healthcare All Payer |
$10.96
|
|
|
ENTOCORT EC(BUDESONIDE)3MG CAP
|
Facility
|
IP
|
$12.45
|
|
|
Service Code
|
NDC 378715501
|
| Hospital Charge Code |
25000623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$11.95 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.71
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cigna Commercial |
$10.33
|
| Rate for Payer: First Health Commercial |
$11.83
|
| Rate for Payer: Humana Commercial |
$10.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.96
|
| Rate for Payer: Ohio Health Group HMO |
$9.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.86
|
| Rate for Payer: PHCS Commercial |
$11.95
|
| Rate for Payer: United Healthcare All Payer |
$10.96
|
|
|
ENTRESTO 24/26 MG
|
Facility
|
OP
|
$28.47
|
|
|
Service Code
|
NDC 78065920
|
| Hospital Charge Code |
25003040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Anthem Medicaid |
$9.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.21
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cigna Commercial |
$23.63
|
| Rate for Payer: First Health Commercial |
$27.05
|
| Rate for Payer: Humana Commercial |
$24.20
|
| Rate for Payer: Humana KY Medicaid |
$9.79
|
| Rate for Payer: Kentucky WC Medicaid |
$9.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.05
|
| Rate for Payer: Ohio Health Group HMO |
$21.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.83
|
| Rate for Payer: PHCS Commercial |
$27.33
|
| Rate for Payer: United Healthcare All Payer |
$25.05
|
|
|
ENTRESTO 24/26 MG
|
Facility
|
IP
|
$28.47
|
|
|
Service Code
|
NDC 78065920
|
| Hospital Charge Code |
25003040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.21
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cigna Commercial |
$23.63
|
| Rate for Payer: First Health Commercial |
$27.05
|
| Rate for Payer: Humana Commercial |
$24.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.05
|
| Rate for Payer: Ohio Health Group HMO |
$21.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.83
|
| Rate for Payer: PHCS Commercial |
$27.33
|
| Rate for Payer: United Healthcare All Payer |
$25.05
|
|
|
ENTRESTO 49/51 MG
|
Facility
|
OP
|
$28.47
|
|
|
Service Code
|
NDC 78077720
|
| Hospital Charge Code |
25003041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Anthem Medicaid |
$9.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.21
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cigna Commercial |
$23.63
|
| Rate for Payer: First Health Commercial |
$27.05
|
| Rate for Payer: Humana Commercial |
$24.20
|
| Rate for Payer: Humana KY Medicaid |
$9.79
|
| Rate for Payer: Kentucky WC Medicaid |
$9.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.05
|
| Rate for Payer: Ohio Health Group HMO |
$21.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.83
|
| Rate for Payer: PHCS Commercial |
$27.33
|
| Rate for Payer: United Healthcare All Payer |
$25.05
|
|
|
ENTRESTO 49/51 MG
|
Facility
|
IP
|
$28.47
|
|
|
Service Code
|
NDC 78077720
|
| Hospital Charge Code |
25003041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.21
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cigna Commercial |
$23.63
|
| Rate for Payer: First Health Commercial |
$27.05
|
| Rate for Payer: Humana Commercial |
$24.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.05
|
| Rate for Payer: Ohio Health Group HMO |
$21.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.83
|
| Rate for Payer: PHCS Commercial |
$27.33
|
| Rate for Payer: United Healthcare All Payer |
$25.05
|
|
|
ENTRESTO 97/103 MG
|
Facility
|
OP
|
$28.47
|
|
|
Service Code
|
NDC 78069620
|
| Hospital Charge Code |
25003042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Anthem Medicaid |
$9.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.21
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cigna Commercial |
$23.63
|
| Rate for Payer: First Health Commercial |
$27.05
|
| Rate for Payer: Humana Commercial |
$24.20
|
| Rate for Payer: Humana KY Medicaid |
$9.79
|
| Rate for Payer: Kentucky WC Medicaid |
$9.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.05
|
| Rate for Payer: Ohio Health Group HMO |
$21.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.83
|
| Rate for Payer: PHCS Commercial |
$27.33
|
| Rate for Payer: United Healthcare All Payer |
$25.05
|
|
|
ENTRESTO 97/103 MG
|
Facility
|
IP
|
$28.47
|
|
|
Service Code
|
NDC 78069620
|
| Hospital Charge Code |
25003042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.21
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cigna Commercial |
$23.63
|
| Rate for Payer: First Health Commercial |
$27.05
|
| Rate for Payer: Humana Commercial |
$24.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.05
|
| Rate for Payer: Ohio Health Group HMO |
$21.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.83
|
| Rate for Payer: PHCS Commercial |
$27.33
|
| Rate for Payer: United Healthcare All Payer |
$25.05
|
|
|
ENTROTOMY SM INT EXPLORATIO
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 44020
|
| Hospital Charge Code |
76101805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,395.47 |
| Rate for Payer: Aetna Commercial |
$1,395.47
|
| Rate for Payer: Anthem Medicaid |
$563.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,291.30
|
| Rate for Payer: Healthspan PPO |
$1,176.82
|
| Rate for Payer: Humana Medicaid |
$563.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,239.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$574.53
|
| Rate for Payer: Molina Healthcare Passport |
$563.26
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$568.89
|
|
|
ENTROTOMY SM INT EXPLORATIO
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 44020
|
| Hospital Charge Code |
76101805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
ENTROTOMY SM INT EXPLORATIO
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 44020
|
| Hospital Charge Code |
76101805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
ENTROTOMY SM INT EXPLORATIO(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 44020
|
| Hospital Charge Code |
761P1805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,395.47 |
| Rate for Payer: Aetna Commercial |
$1,395.47
|
| Rate for Payer: Anthem Medicaid |
$563.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,291.30
|
| Rate for Payer: Healthspan PPO |
$1,176.82
|
| Rate for Payer: Humana Medicaid |
$563.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,239.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$574.53
|
| Rate for Payer: Molina Healthcare Passport |
$563.26
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$568.89
|
|
|
ENTRY GUIDEWIRE 3.2M*46C
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.40 |
| Max. Negotiated Rate |
$1,900.80 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$613.80
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
|
ENTRY GUIDEWIRE 3.2M*46C
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.40 |
| Max. Negotiated Rate |
$1,900.80 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem Medicaid |
$680.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Humana KY Medicaid |
$680.92
|
| Rate for Payer: Kentucky WC Medicaid |
$687.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$613.80
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
|
ENTYVIO 1 MG (300MG VIAL)
|
Facility
|
IP
|
$47,232.86
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
25002419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,140.27 |
| Max. Negotiated Rate |
$45,343.55 |
| Rate for Payer: Aetna Commercial |
$36,369.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36,841.63
|
| Rate for Payer: Cash Price |
$23,616.43
|
| Rate for Payer: Cigna Commercial |
$39,203.27
|
| Rate for Payer: First Health Commercial |
$44,871.22
|
| Rate for Payer: Humana Commercial |
$40,147.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38,730.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34,857.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,169.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$41,564.92
|
| Rate for Payer: Ohio Health Group HMO |
$35,424.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,446.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,140.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,642.19
|
| Rate for Payer: PHCS Commercial |
$45,343.55
|
| Rate for Payer: United Healthcare All Payer |
$41,564.92
|
|
|
ENTYVIO 1 MG (300MG VIAL)
|
Facility
|
OP
|
$47,232.86
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
25002419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$45,343.55 |
| Rate for Payer: Aetna Commercial |
$36,369.30
|
| Rate for Payer: Anthem Medicaid |
$16,243.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36,841.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.79
|
| Rate for Payer: Cash Price |
$23,616.43
|
| Rate for Payer: Cash Price |
$23,616.43
|
| Rate for Payer: Cigna Commercial |
$39,203.27
|
| Rate for Payer: First Health Commercial |
$44,871.22
|
| Rate for Payer: Humana Commercial |
$40,147.93
|
| Rate for Payer: Humana KY Medicaid |
$16,243.38
|
| Rate for Payer: Humana Medicare Advantage |
$22.06
|
| Rate for Payer: Kentucky WC Medicaid |
$16,408.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38,730.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34,857.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,569.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$41,564.92
|
| Rate for Payer: Ohio Health Group HMO |
$35,424.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,446.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,140.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,642.19
|
| Rate for Payer: PHCS Commercial |
$45,343.55
|
| Rate for Payer: United Healthcare All Payer |
$41,564.92
|
|
|
EONC NON-RECHARABLE IPG 3688
|
Facility
|
OP
|
$80,098.90
|
|
|
Service Code
|
HCPCS C1767
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,412.86 |
| Max. Negotiated Rate |
$76,894.94 |
| Rate for Payer: Aetna Commercial |
$61,676.15
|
| Rate for Payer: Anthem Medicaid |
$27,546.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,477.14
|
| Rate for Payer: Cash Price |
$40,049.45
|
| Rate for Payer: Cigna Commercial |
$66,482.09
|
| Rate for Payer: First Health Commercial |
$76,093.96
|
| Rate for Payer: Humana Commercial |
$68,084.06
|
| Rate for Payer: Humana KY Medicaid |
$27,546.01
|
| Rate for Payer: Kentucky WC Medicaid |
$27,826.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,681.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,112.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,029.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,098.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,487.03
|
| Rate for Payer: Ohio Health Group HMO |
$60,074.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,019.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,412.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,830.66
|
| Rate for Payer: PHCS Commercial |
$76,894.94
|
| Rate for Payer: United Healthcare All Payer |
$70,487.03
|
|
|
EONC NON-RECHARABLE IPG 3688
|
Facility
|
IP
|
$80,098.90
|
|
|
Service Code
|
HCPCS C1767
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,412.86 |
| Max. Negotiated Rate |
$76,894.94 |
| Rate for Payer: Aetna Commercial |
$61,676.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,477.14
|
| Rate for Payer: Cash Price |
$40,049.45
|
| Rate for Payer: Cigna Commercial |
$66,482.09
|
| Rate for Payer: First Health Commercial |
$76,093.96
|
| Rate for Payer: Humana Commercial |
$68,084.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,681.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,112.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,029.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,487.03
|
| Rate for Payer: Ohio Health Group HMO |
$60,074.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,019.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,412.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,830.66
|
| Rate for Payer: PHCS Commercial |
$76,894.94
|
| Rate for Payer: United Healthcare All Payer |
$70,487.03
|
|
|
EOSINOPHIL STOOL/URINE
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
30001326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
EOSINOPHIL STOOL/URINE
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
30001326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
EOVIST.25MMOL/1ML 2.5MMOL/10ML
|
Facility
|
IP
|
$180.46
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
25001804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$173.24 |
| Rate for Payer: Aetna Commercial |
$138.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.76
|
| Rate for Payer: Cash Price |
$90.23
|
| Rate for Payer: Cigna Commercial |
$149.78
|
| Rate for Payer: First Health Commercial |
$171.44
|
| Rate for Payer: Humana Commercial |
$153.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.80
|
| Rate for Payer: Ohio Health Group HMO |
$135.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.94
|
| Rate for Payer: PHCS Commercial |
$173.24
|
| Rate for Payer: United Healthcare All Payer |
$158.80
|
|
|
EOVIST.25MMOL/1ML 2.5MMOL/10ML
|
Facility
|
OP
|
$180.46
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
25001804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$173.24 |
| Rate for Payer: Humana Commercial |
$153.39
|
| Rate for Payer: Humana KY Medicaid |
$62.06
|
| Rate for Payer: Kentucky WC Medicaid |
$62.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.80
|
| Rate for Payer: Ohio Health Group HMO |
$135.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.94
|
| Rate for Payer: PHCS Commercial |
$173.24
|
| Rate for Payer: United Healthcare All Payer |
$158.80
|
| Rate for Payer: Aetna Commercial |
$138.95
|
| Rate for Payer: Anthem Medicaid |
$62.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.76
|
| Rate for Payer: Cash Price |
$90.23
|
| Rate for Payer: Cigna Commercial |
$149.78
|
| Rate for Payer: First Health Commercial |
$171.44
|
|
