|
ENSURE PLUS 237
|
Facility
|
OP
|
$66.51
|
|
|
Service Code
|
HCPCS B4152
|
| Hospital Charge Code |
25004538
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$63.85 |
| Rate for Payer: Aetna Commercial |
$51.21
|
| Rate for Payer: Anthem Medicaid |
$22.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.88
|
| Rate for Payer: Cash Price |
$33.26
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: First Health Commercial |
$63.18
|
| Rate for Payer: Humana Commercial |
$56.53
|
| Rate for Payer: Humana KY Medicaid |
$22.87
|
| Rate for Payer: Kentucky WC Medicaid |
$23.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.53
|
| Rate for Payer: Ohio Health Group HMO |
$49.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.89
|
| Rate for Payer: PHCS Commercial |
$63.85
|
| Rate for Payer: United Healthcare All Payer |
$58.53
|
|
|
ENSURE PRE SURGERY LIQUID
|
Facility
|
OP
|
$10.65
|
|
|
Service Code
|
NDC 70074065044
|
| Hospital Charge Code |
25003039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$10.22 |
| 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
|
| 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 |
$3.19
|
| 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 |
$8.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.35
|
| Rate for Payer: PHCS Commercial |
$10.22
|
| Rate for Payer: United Healthcare All Payer |
$9.37
|
|
|
ENSURE PRE SURGERY LIQUID
|
Facility
|
IP
|
$10.65
|
|
|
Service Code
|
NDC 70074065044
|
| Hospital Charge Code |
25003039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.19 |
| 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 |
$3.19
|
| 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 |
$8.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.35
|
| 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 |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
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 |
$1,753.55 |
| Rate for Payer: Aetna Commercial |
$1,753.55
|
| Rate for Payer: Ambetter Exchange |
$1,164.12
|
| Rate for Payer: Anthem Medicaid |
$688.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,164.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,164.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,396.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,164.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.12
|
| 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 |
$1,513.36
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$695.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,164.12
|
|
|
ENTERECTOMY - RESECTION OF SM
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44120
|
| Hospital Charge Code |
76101810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| 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 |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
ENTERECTOMY - RESECTION OF SM
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44120
|
| Hospital Charge Code |
76101810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| 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 |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
ENTERECTOMY - RESECTION OF SM
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 44121
|
| Hospital Charge Code |
76101811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.93 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$366.11
|
| Rate for Payer: Ambetter Exchange |
$228.17
|
| Rate for Payer: Anthem Medicaid |
$205.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$228.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$228.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$273.80
|
| 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 |
$308.75
|
| Rate for Payer: Humana Medicaid |
$205.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$313.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$228.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.17
|
| 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 |
$296.62
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$207.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$228.17
|
|
|
ENTERECTOMY - RESECTION OF SM
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 44121
|
| Hospital Charge Code |
76101811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
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 |
$1,753.55 |
| Rate for Payer: Aetna Commercial |
$1,753.55
|
| Rate for Payer: Ambetter Exchange |
$1,164.12
|
| Rate for Payer: Anthem Medicaid |
$688.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,164.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,164.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,396.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,164.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.12
|
| 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 |
$1,513.36
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$695.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,164.12
|
|
|
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 |
$600.00 |
| Rate for Payer: Aetna Commercial |
$366.11
|
| Rate for Payer: Ambetter Exchange |
$228.17
|
| Rate for Payer: Anthem Medicaid |
$205.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$228.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$228.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$273.80
|
| 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 |
$308.75
|
| Rate for Payer: Humana Medicaid |
$205.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$313.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$228.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.17
|
| 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 |
$296.62
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$207.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$228.17
|
|
|
ENTEREG 12MG CAPSULE
|
Facility
|
OP
|
$327.11
|
|
|
Service Code
|
NDC 254301255
|
| Hospital Charge Code |
25000622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.13 |
| 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 |
$261.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.71
|
| Rate for Payer: PHCS Commercial |
$314.03
|
| Rate for Payer: United Healthcare All Payer |
$287.86
|
|
|
ENTEREG 12MG CAPSULE
|
Facility
|
IP
|
$327.11
|
|
|
Service Code
|
NDC 254301255
|
| Hospital Charge Code |
25000622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.13 |
| 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 |
$261.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.71
|
| Rate for Payer: PHCS Commercial |
$314.03
|
| Rate for Payer: United Healthcare All Payer |
$287.86
|
|
|
ENTERIC PATHOGEN MOLECULAR PAN
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS 87506
|
| Hospital Charge Code |
30001373
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$262.99 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$637.56
|
| Rate for Payer: Anthem Medicaid |
$262.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$262.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$664.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$368.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.99
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: Humana Commercial |
$703.80
|
| 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 |
$678.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$268.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$728.64
|
| Rate for Payer: Ohio Health Group HMO |
$621.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.32
|
| Rate for Payer: PHCS Commercial |
$794.88
|
| Rate for Payer: United Healthcare All Payer |
$728.64
|
|
|
ENTERIC PATHOGEN MOLECULAR PAN
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS 87506
|
| Hospital Charge Code |
30001373
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$637.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$664.88
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: Humana Commercial |
$703.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$728.64
|
| Rate for Payer: Ohio Health Group HMO |
$621.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.32
|
| Rate for Payer: PHCS Commercial |
$794.88
|
| Rate for Payer: United Healthcare All Payer |
$728.64
|
|
|
ENTEROBACTER GYRB METB GENES
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001311
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
ENTEROBACTER GYRB METB GENES
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001311
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| 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 |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
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 |
$1,206.99 |
| Rate for Payer: Aetna Commercial |
$1,206.99
|
| Rate for Payer: Ambetter Exchange |
$801.91
|
| Rate for Payer: Anthem Medicaid |
$421.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$801.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$801.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$962.29
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$801.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$801.91
|
| 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 |
$1,042.48
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$801.91
|
|
|
ENTEROSTOMY OR CECOSTOMY - TU
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44300
|
| Hospital Charge Code |
76101835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.00 |
| 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 |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| 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 |
$1,206.99 |
| Rate for Payer: Aetna Commercial |
$1,206.99
|
| Rate for Payer: Ambetter Exchange |
$801.91
|
| Rate for Payer: Anthem Medicaid |
$421.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$801.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$801.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$962.29
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$801.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$801.91
|
| 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 |
$1,042.48
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$801.91
|
|
|
ENTEROSTOMY OR CECOSTOMY - TU
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44300
|
| Hospital Charge Code |
76101835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.00 |
| 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 |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
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 |
$421.28 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem Medicaid |
$421.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| 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 |
$1,752.78
|
| 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 |
$2,103.34
|
| 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 |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$845.25
|
| 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 |
$222.98 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$398.30
|
| Rate for Payer: Ambetter Exchange |
$222.98
|
| Rate for Payer: Anthem Medicaid |
$313.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$222.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$222.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$267.58
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$222.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.98
|
| 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 |
$289.87
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$317.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$222.98
|
|
|
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 |
$367.50 |
| 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 |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$845.25
|
| 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 |
$222.98 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$398.30
|
| Rate for Payer: Ambetter Exchange |
$222.98
|
| Rate for Payer: Anthem Medicaid |
$313.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$222.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$222.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$267.58
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$222.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.98
|
| 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 |
$289.87
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$317.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$222.98
|
|
