|
CHOLANGIOGRAM T-TUBE
|
Facility
|
OP
|
$4,901.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
32000372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$637.13 |
| Max. Negotiated Rate |
$4,704.96 |
| Rate for Payer: Aetna Commercial |
$3,773.77
|
| Rate for Payer: Anthem Medicaid |
$1,685.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cigna Commercial |
$4,067.83
|
| Rate for Payer: First Health Commercial |
$4,655.95
|
| Rate for Payer: Humana Commercial |
$4,165.85
|
| Rate for Payer: Humana KY Medicaid |
$1,685.45
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,719.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.31
|
| Rate for Payer: PHCS Commercial |
$4,704.96
|
| Rate for Payer: United Healthcare All Payer |
$4,312.88
|
|
|
CHOLANGIOGRAM T-TUBE(P
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
761P1956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.25 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.25
|
| Rate for Payer: Anthem Medicaid |
$78.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$555.00
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$160.14
|
| Rate for Payer: Humana Medicaid |
$78.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.94
|
| Rate for Payer: Molina Healthcare Passport |
$78.37
|
| Rate for Payer: Multiplan PHCS |
$333.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.50
|
| Rate for Payer: UHCCP Medicaid |
$73.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.15
|
|
|
CHOLANGIOGRAM T-TUBE(P
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
320P0372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.25 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.25
|
| Rate for Payer: Anthem Medicaid |
$78.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$555.00
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$160.14
|
| Rate for Payer: Humana Medicaid |
$78.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.94
|
| Rate for Payer: Molina Healthcare Passport |
$78.37
|
| Rate for Payer: Multiplan PHCS |
$333.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.50
|
| Rate for Payer: UHCCP Medicaid |
$73.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.15
|
|
|
CHOLANGIOGRAM T-TUBE(T
|
Facility
|
OP
|
$4,346.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
320T0372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.98 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$3,346.42
|
| Rate for Payer: Anthem Medicaid |
$1,494.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,389.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$2,173.00
|
| Rate for Payer: Cash Price |
$2,173.00
|
| Rate for Payer: Cigna Commercial |
$3,607.18
|
| Rate for Payer: First Health Commercial |
$4,128.70
|
| Rate for Payer: Humana Commercial |
$3,694.10
|
| Rate for Payer: Humana KY Medicaid |
$1,494.59
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,563.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,207.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,524.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,824.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,259.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.26
|
| Rate for Payer: PHCS Commercial |
$4,172.16
|
| Rate for Payer: United Healthcare All Payer |
$3,824.48
|
|
|
CHOLANGIOGRAM T-TUBE(T
|
Facility
|
OP
|
$4,346.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
761T1956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.98 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$3,346.42
|
| Rate for Payer: Anthem Medicaid |
$1,494.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,389.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$2,173.00
|
| Rate for Payer: Cash Price |
$2,173.00
|
| Rate for Payer: Cigna Commercial |
$3,607.18
|
| Rate for Payer: First Health Commercial |
$4,128.70
|
| Rate for Payer: Humana Commercial |
$3,694.10
|
| Rate for Payer: Humana KY Medicaid |
$1,494.59
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,563.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,207.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,524.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,824.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,259.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.26
|
| Rate for Payer: PHCS Commercial |
$4,172.16
|
| Rate for Payer: United Healthcare All Payer |
$3,824.48
|
|
|
CHOLANGIOGRAM T-TUBE(T
|
Facility
|
IP
|
$4,346.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
320T0372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.98 |
| Max. Negotiated Rate |
$4,172.16 |
| Rate for Payer: Aetna Commercial |
$3,346.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,389.88
|
| Rate for Payer: Cash Price |
$2,173.00
|
| Rate for Payer: Cigna Commercial |
$3,607.18
|
| Rate for Payer: First Health Commercial |
$4,128.70
|
| Rate for Payer: Humana Commercial |
$3,694.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,563.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,207.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,824.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,259.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.26
|
| Rate for Payer: PHCS Commercial |
$4,172.16
|
| Rate for Payer: United Healthcare All Payer |
$3,824.48
|
|
|
CHOLANGIOGRAM T-TUBE(T
|
Facility
|
IP
|
$4,346.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
761T1956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.98 |
| Max. Negotiated Rate |
$4,172.16 |
| Rate for Payer: Aetna Commercial |
$3,346.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,389.88
|
| Rate for Payer: Cash Price |
$2,173.00
|
| Rate for Payer: Cigna Commercial |
$3,607.18
|
| Rate for Payer: First Health Commercial |
$4,128.70
|
| Rate for Payer: Humana Commercial |
$3,694.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,563.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,207.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,824.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,259.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.26
|
| Rate for Payer: PHCS Commercial |
$4,172.16
|
| Rate for Payer: United Healthcare All Payer |
$3,824.48
|
|
|
CHOLECALCIFEROL(VIT D3) 5000
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 50268086615
|
| Hospital Charge Code |
25000417
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
CHOLECALCIFEROL(VIT D3) 5000
|
Facility
|
IP
|
$4.47
|
|
|
Service Code
|
NDC 50268086615
|
| Hospital Charge Code |
25000417
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
CHOLECYSTECTOMY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 47600
|
| Hospital Charge Code |
76101967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,511.89
|
| Rate for Payer: Anthem Medicaid |
$553.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,375.95
|
| Rate for Payer: Healthspan PPO |
$1,275.01
|
| Rate for Payer: Humana Medicaid |
$553.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,369.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.82
|
| Rate for Payer: Molina Healthcare Passport |
$553.75
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$559.29
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 47600
|
| Hospital Charge Code |
76101967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
CHOLECYSTECTOMY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 47600
|
| Hospital Charge Code |
76101967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$23,113.31
|
|
|
Service Code
|
MSDRG 415
|
| Min. Negotiated Rate |
$15,684.03 |
| Max. Negotiated Rate |
$23,113.31 |
| Rate for Payer: Anthem Medicaid |
$15,684.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,509.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,113.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,287.84
|
| Rate for Payer: Humana KY Medicaid |
$15,684.03
|
| Rate for Payer: Humana Medicare Advantage |
$16,509.51
|
| Rate for Payer: Kentucky WC Medicaid |
$15,840.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,811.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,997.72
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$41,238.51
|
|
|
Service Code
|
MSDRG 414
|
| Min. Negotiated Rate |
$27,983.28 |
| Max. Negotiated Rate |
$41,238.51 |
| Rate for Payer: Anthem Medicaid |
$27,983.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29,456.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41,238.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$39,765.71
|
| Rate for Payer: Humana KY Medicaid |
$27,983.28
|
| Rate for Payer: Humana Medicare Advantage |
$29,456.08
|
| Rate for Payer: Kentucky WC Medicaid |
$28,263.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,347.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,542.94
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$15,666.24
|
|
|
Service Code
|
MSDRG 416
|
| Min. Negotiated Rate |
$10,630.66 |
| Max. Negotiated Rate |
$15,666.24 |
| Rate for Payer: Anthem Medicaid |
$10,630.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,190.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,666.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,106.73
|
| Rate for Payer: Humana KY Medicaid |
$10,630.66
|
| Rate for Payer: Humana Medicare Advantage |
$11,190.17
|
| Rate for Payer: Kentucky WC Medicaid |
$10,736.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,428.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,843.27
|
|
|
CHOLECYSTECTOMY(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 47600
|
| Hospital Charge Code |
761P1967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,511.89
|
| Rate for Payer: Anthem Medicaid |
$553.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,375.95
|
| Rate for Payer: Healthspan PPO |
$1,275.01
|
| Rate for Payer: Humana Medicaid |
$553.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,369.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.82
|
| Rate for Payer: Molina Healthcare Passport |
$553.75
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$559.29
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH CC
|
Facility
|
IP
|
$24,169.67
|
|
|
Service Code
|
MSDRG 412
|
| Min. Negotiated Rate |
$16,400.85 |
| Max. Negotiated Rate |
$24,169.67 |
| Rate for Payer: Anthem Medicaid |
$16,400.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,264.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,169.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,306.47
|
| Rate for Payer: Humana KY Medicaid |
$16,400.85
|
| Rate for Payer: Humana Medicare Advantage |
$17,264.05
|
| Rate for Payer: Kentucky WC Medicaid |
$16,564.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,716.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,728.86
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH MCC
|
Facility
|
IP
|
$35,567.21
|
|
|
Service Code
|
MSDRG 411
|
| Min. Negotiated Rate |
$24,134.89 |
| Max. Negotiated Rate |
$35,567.21 |
| Rate for Payer: Anthem Medicaid |
$24,134.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25,405.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35,567.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$34,296.95
|
| Rate for Payer: Humana KY Medicaid |
$24,134.89
|
| Rate for Payer: Humana Medicare Advantage |
$25,405.15
|
| Rate for Payer: Kentucky WC Medicaid |
$24,376.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,486.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,617.59
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$17,659.61
|
|
|
Service Code
|
MSDRG 413
|
| Min. Negotiated Rate |
$11,983.31 |
| Max. Negotiated Rate |
$17,659.61 |
| Rate for Payer: Anthem Medicaid |
$11,983.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,614.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,659.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,028.91
|
| Rate for Payer: Humana KY Medicaid |
$11,983.31
|
| Rate for Payer: Humana Medicare Advantage |
$12,614.01
|
| Rate for Payer: Kentucky WC Medicaid |
$12,103.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,136.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,222.98
|
|
|
CHOLECYSTECTOMY; WITH CHOLANGI
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 47605
|
| Hospital Charge Code |
76101968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
CHOLECYSTECTOMY; WITH CHOLANGI
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 47605
|
| Hospital Charge Code |
76101968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.19 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,408.88
|
| Rate for Payer: Anthem Medicaid |
$599.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,311.57
|
| Rate for Payer: Healthspan PPO |
$1,188.14
|
| Rate for Payer: Humana Medicaid |
$599.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,248.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$611.17
|
| Rate for Payer: Molina Healthcare Passport |
$599.19
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$605.18
|
|
|
CHOLECYSTECTOMY; WITH CHOLANGI
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 47605
|
| Hospital Charge Code |
761P1968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.19 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,408.88
|
| Rate for Payer: Anthem Medicaid |
$599.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,311.57
|
| Rate for Payer: Healthspan PPO |
$1,188.14
|
| Rate for Payer: Humana Medicaid |
$599.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,248.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$611.17
|
| Rate for Payer: Molina Healthcare Passport |
$599.19
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$605.18
|
|
|
CHOLECYSTECTOMY; WITH CHOLANGI
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 47605
|
| Hospital Charge Code |
76101968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
CHOLECYSTOSTOMY W/IMAG
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 47490
|
| Hospital Charge Code |
76101955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.22 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$794.55
|
| Rate for Payer: Anthem Medicaid |
$282.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$745.17
|
| Rate for Payer: Healthspan PPO |
$670.06
|
| Rate for Payer: Humana Medicaid |
$282.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$461.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$287.86
|
| Rate for Payer: Molina Healthcare Passport |
$282.22
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.04
|
|
|
CHOLECYSTOSTOMY W/IMAG
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 47490
|
| Hospital Charge Code |
76101955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
