|
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 |
$407.52 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$912.45
|
| Rate for Payer: Anthem Medicaid |
$407.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.30
|
| 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 |
$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 |
$1,752.78
|
| 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 |
$2,103.34
|
| 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 |
$948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.65
|
| 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 |
761P1846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.89 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Aetna Commercial |
$389.19
|
| Rate for Payer: Ambetter Exchange |
$223.89
|
| Rate for Payer: Anthem Medicaid |
$318.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$268.67
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$223.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.89
|
| 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 |
$291.06
|
| Rate for Payer: UHCCP Medicaid |
$414.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.89
|
|
|
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 |
$355.50 |
| 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 |
$948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.65
|
| 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 |
$223.89 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Aetna Commercial |
$389.19
|
| Rate for Payer: Ambetter Exchange |
$223.89
|
| Rate for Payer: Anthem Medicaid |
$318.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$268.67
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$223.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.89
|
| 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 |
$291.06
|
| Rate for Payer: UHCCP Medicaid |
$414.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.89
|
|
|
ENT FAECALIS HSP60 GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001301
|
|
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
|
|
|
ENT FAECALIS HSP60 GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001301
|
|
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
|
|
|
ENT FAECLUM HSP60 GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001297
|
|
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
|
|
|
ENT FAECLUM HSP60 GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001297
|
|
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
|
|
|
ENTOCORT EC(BUDESONIDE)3MG CAP
|
Facility
|
IP
|
$12.45
|
|
|
Service Code
|
NDC 378715501
|
| Hospital Charge Code |
25000623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.73 |
| 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 |
$3.73
|
| 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 |
$9.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.59
|
| Rate for Payer: PHCS Commercial |
$11.95
|
| Rate for Payer: United Healthcare All Payer |
$10.96
|
|
|
ENTOCORT EC(BUDESONIDE)3MG CAP
|
Facility
|
OP
|
$12.45
|
|
|
Service Code
|
NDC 378715501
|
| Hospital Charge Code |
25000623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.73 |
| 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 |
$3.73
|
| 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 |
$9.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.59
|
| Rate for Payer: PHCS Commercial |
$11.95
|
| Rate for Payer: United Healthcare All Payer |
$10.96
|
|
|
ENTRESTO 24/26 MG
|
Facility
|
IP
|
$28.75
|
|
|
Service Code
|
NDC 78065920
|
| Hospital Charge Code |
25003040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$22.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.43
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cigna Commercial |
$23.86
|
| Rate for Payer: First Health Commercial |
$27.31
|
| Rate for Payer: Humana Commercial |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.30
|
| Rate for Payer: Ohio Health Group HMO |
$21.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$27.60
|
| Rate for Payer: United Healthcare All Payer |
$25.30
|
|
|
ENTRESTO 24/26 MG
|
Facility
|
OP
|
$28.75
|
|
|
Service Code
|
NDC 78065920
|
| Hospital Charge Code |
25003040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$22.14
|
| Rate for Payer: Anthem Medicaid |
$9.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.43
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cigna Commercial |
$23.86
|
| Rate for Payer: First Health Commercial |
$27.31
|
| Rate for Payer: Humana Commercial |
$24.44
|
| Rate for Payer: Humana KY Medicaid |
$9.89
|
| Rate for Payer: Kentucky WC Medicaid |
$9.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.30
|
| Rate for Payer: Ohio Health Group HMO |
$21.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$27.60
|
| Rate for Payer: United Healthcare All Payer |
$25.30
|
|
|
ENTRESTO 49/51 MG
|
Facility
|
OP
|
$28.75
|
|
|
Service Code
|
NDC 78077720
|
| Hospital Charge Code |
25003041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$22.14
|
| Rate for Payer: Anthem Medicaid |
$9.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.43
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cigna Commercial |
$23.86
|
| Rate for Payer: First Health Commercial |
$27.31
|
| Rate for Payer: Humana Commercial |
$24.44
|
| Rate for Payer: Humana KY Medicaid |
$9.89
|
| Rate for Payer: Kentucky WC Medicaid |
$9.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.30
|
| Rate for Payer: Ohio Health Group HMO |
$21.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$27.60
|
| Rate for Payer: United Healthcare All Payer |
$25.30
|
|
|
ENTRESTO 49/51 MG
|
Facility
|
IP
|
$28.75
|
|
|
Service Code
|
NDC 78077720
|
| Hospital Charge Code |
25003041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$22.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.43
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cigna Commercial |
$23.86
|
| Rate for Payer: First Health Commercial |
$27.31
|
| Rate for Payer: Humana Commercial |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.30
|
| Rate for Payer: Ohio Health Group HMO |
$21.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$27.60
|
| Rate for Payer: United Healthcare All Payer |
$25.30
|
|
|
ENTRESTO 97/103 MG
|
Facility
|
IP
|
$28.75
|
|
|
Service Code
|
NDC 78069620
|
| Hospital Charge Code |
25003042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$22.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.43
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cigna Commercial |
$23.86
|
| Rate for Payer: First Health Commercial |
$27.31
|
| Rate for Payer: Humana Commercial |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.30
|
| Rate for Payer: Ohio Health Group HMO |
$21.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$27.60
|
| Rate for Payer: United Healthcare All Payer |
$25.30
|
|
|
ENTRESTO 97/103 MG
|
Facility
|
OP
|
$28.75
|
|
|
Service Code
|
NDC 78069620
|
| Hospital Charge Code |
25003042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$22.14
|
| Rate for Payer: Anthem Medicaid |
$9.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.43
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cigna Commercial |
$23.86
|
| Rate for Payer: First Health Commercial |
$27.31
|
| Rate for Payer: Humana Commercial |
$24.44
|
| Rate for Payer: Humana KY Medicaid |
$9.89
|
| Rate for Payer: Kentucky WC Medicaid |
$9.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.30
|
| Rate for Payer: Ohio Health Group HMO |
$21.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$27.60
|
| Rate for Payer: United Healthcare All Payer |
$25.30
|
|
|
ENTROTOMY SM INT EXPLORATIO
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 44020
|
| Hospital Charge Code |
76101805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| 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 |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
ENTROTOMY SM INT EXPLORATIO
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 44020
|
| Hospital Charge Code |
76101805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| 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 |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
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: Ambetter Exchange |
$929.93
|
| Rate for Payer: Anthem Medicaid |
$563.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$929.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$929.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,115.92
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$929.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.93
|
| 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 |
$1,208.91
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$568.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$929.93
|
|
|
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: Ambetter Exchange |
$929.93
|
| Rate for Payer: Anthem Medicaid |
$563.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$929.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$929.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,115.92
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$929.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.93
|
| 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 |
$1,208.91
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$568.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$929.93
|
|
|
ENTRY GUIDEWIRE 3.2M*46C
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
ENTRY GUIDEWIRE 3.2M*46C
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem Medicaid |
$682.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Humana KY Medicaid |
$682.30
|
| Rate for Payer: Kentucky WC Medicaid |
$689.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
ENTYVIO 1 MG (300MG VIAL)
|
Facility
|
IP
|
$51,011.51
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
25002419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,303.45 |
| Max. Negotiated Rate |
$48,971.05 |
| Rate for Payer: Aetna Commercial |
$39,278.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39,788.98
|
| Rate for Payer: Cash Price |
$25,505.76
|
| Rate for Payer: Cigna Commercial |
$42,339.55
|
| Rate for Payer: First Health Commercial |
$48,460.93
|
| Rate for Payer: Humana Commercial |
$43,359.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41,829.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37,646.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,303.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$44,890.13
|
| Rate for Payer: Ohio Health Group HMO |
$38,258.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40,809.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44,380.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35,197.94
|
| Rate for Payer: PHCS Commercial |
$48,971.05
|
| Rate for Payer: United Healthcare All Payer |
$44,890.13
|
|
|
ENTYVIO 1 MG (300MG VIAL)
|
Facility
|
OP
|
$51,011.51
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
25002419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$48,971.05 |
| Rate for Payer: Aetna Commercial |
$39,278.86
|
| Rate for Payer: Anthem Medicaid |
$17,542.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39,788.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.78
|
| Rate for Payer: Cash Price |
$25,505.76
|
| Rate for Payer: Cash Price |
$25,505.76
|
| Rate for Payer: Cigna Commercial |
$42,339.55
|
| Rate for Payer: First Health Commercial |
$48,460.93
|
| Rate for Payer: Humana Commercial |
$43,359.78
|
| Rate for Payer: Humana KY Medicaid |
$17,542.86
|
| Rate for Payer: Humana Medicare Advantage |
$22.06
|
| Rate for Payer: Kentucky WC Medicaid |
$17,721.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41,829.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37,646.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,894.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$44,890.13
|
| Rate for Payer: Ohio Health Group HMO |
$38,258.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40,809.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44,380.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35,197.94
|
| Rate for Payer: PHCS Commercial |
$48,971.05
|
| Rate for Payer: United Healthcare All Payer |
$44,890.13
|
|
|
EONC NON-RECHARABLE IPG 3688
|
Facility
|
OP
|
$82,909.95
|
|
|
Service Code
|
HCPCS C1767
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,872.99 |
| Max. Negotiated Rate |
$79,593.55 |
| Rate for Payer: Aetna Commercial |
$63,840.66
|
| Rate for Payer: Anthem Medicaid |
$28,512.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,669.76
|
| Rate for Payer: Cash Price |
$41,454.97
|
| Rate for Payer: Cigna Commercial |
$68,815.26
|
| Rate for Payer: First Health Commercial |
$78,764.45
|
| Rate for Payer: Humana Commercial |
$70,473.46
|
| Rate for Payer: Humana KY Medicaid |
$28,512.73
|
| Rate for Payer: Kentucky WC Medicaid |
$28,802.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,986.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,187.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,872.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,084.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,960.76
|
| Rate for Payer: Ohio Health Group HMO |
$62,182.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,327.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72,131.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,207.87
|
| Rate for Payer: PHCS Commercial |
$79,593.55
|
| Rate for Payer: United Healthcare All Payer |
$72,960.76
|
|
