|
CHOLANGIOGRAM T-TUBE
|
Facility
|
IP
|
$5,183.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
76101956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,554.90 |
| Max. Negotiated Rate |
$4,975.68 |
| Rate for Payer: Aetna Commercial |
$3,990.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,042.74
|
| Rate for Payer: Cash Price |
$2,591.50
|
| Rate for Payer: Cigna Commercial |
$4,301.89
|
| Rate for Payer: First Health Commercial |
$4,923.85
|
| Rate for Payer: Humana Commercial |
$4,405.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,250.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,825.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,554.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,561.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,509.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,576.27
|
| Rate for Payer: PHCS Commercial |
$4,975.68
|
| Rate for Payer: United Healthcare All Payer |
$4,561.04
|
|
|
CHOLANGIOGRAM T-TUBE(P
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
320P0372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Ambetter Exchange |
$65.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.25
|
| Rate for Payer: Anthem Medicaid |
$279.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.66
|
| 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 |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.25
|
| Rate for Payer: Molina Healthcare Passport |
$279.66
|
| Rate for Payer: Multiplan PHCS |
$333.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.22
|
| Rate for Payer: UHCCP Medicaid |
$73.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.55
|
|
|
CHOLANGIOGRAM T-TUBE(P
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
761P1956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Ambetter Exchange |
$65.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.25
|
| Rate for Payer: Anthem Medicaid |
$279.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.66
|
| 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 |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.25
|
| Rate for Payer: Molina Healthcare Passport |
$279.66
|
| Rate for Payer: Multiplan PHCS |
$333.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.22
|
| Rate for Payer: UHCCP Medicaid |
$73.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.55
|
|
|
CHOLANGIOGRAM T-TUBE(T
|
Facility
|
OP
|
$4,498.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
320T0372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,546.86 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$3,463.46
|
| Rate for Payer: Anthem Medicaid |
$1,546.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$2,249.00
|
| Rate for Payer: Cash Price |
$2,249.00
|
| Rate for Payer: Cigna Commercial |
$3,733.34
|
| Rate for Payer: First Health Commercial |
$4,273.10
|
| Rate for Payer: Humana Commercial |
$3,823.30
|
| Rate for Payer: Humana KY Medicaid |
$1,546.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,688.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,577.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,958.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,598.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,913.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,103.62
|
| Rate for Payer: PHCS Commercial |
$4,318.08
|
| Rate for Payer: United Healthcare All Payer |
$3,958.24
|
|
|
CHOLANGIOGRAM T-TUBE(T
|
Facility
|
OP
|
$4,628.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
761T1956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,591.57 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$3,563.56
|
| Rate for Payer: Anthem Medicaid |
$1,591.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,609.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$2,314.00
|
| Rate for Payer: Cash Price |
$2,314.00
|
| Rate for Payer: Cigna Commercial |
$3,841.24
|
| Rate for Payer: First Health Commercial |
$4,396.60
|
| Rate for Payer: Humana Commercial |
$3,933.80
|
| Rate for Payer: Humana KY Medicaid |
$1,591.57
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,607.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,794.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,415.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,623.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,072.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,471.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,702.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,026.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,193.32
|
| Rate for Payer: PHCS Commercial |
$4,442.88
|
| Rate for Payer: United Healthcare All Payer |
$4,072.64
|
|
|
CHOLANGIOGRAM T-TUBE(T
|
Facility
|
IP
|
$4,498.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
320T0372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,349.40 |
| Max. Negotiated Rate |
$4,318.08 |
| Rate for Payer: Aetna Commercial |
$3,463.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.44
|
| Rate for Payer: Cash Price |
$2,249.00
|
| Rate for Payer: Cigna Commercial |
$3,733.34
|
| Rate for Payer: First Health Commercial |
$4,273.10
|
| Rate for Payer: Humana Commercial |
$3,823.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,688.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,958.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,598.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,913.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,103.62
|
| Rate for Payer: PHCS Commercial |
$4,318.08
|
| Rate for Payer: United Healthcare All Payer |
$3,958.24
|
|
|
CHOLANGIOGRAM T-TUBE(T
|
Facility
|
IP
|
$4,628.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
761T1956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,388.40 |
| Max. Negotiated Rate |
$4,442.88 |
| Rate for Payer: Aetna Commercial |
$3,563.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,609.84
|
| Rate for Payer: Cash Price |
$2,314.00
|
| Rate for Payer: Cigna Commercial |
$3,841.24
|
| Rate for Payer: First Health Commercial |
$4,396.60
|
| Rate for Payer: Humana Commercial |
$3,933.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,794.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,415.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,388.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,072.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,471.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,702.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,026.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,193.32
|
| Rate for Payer: PHCS Commercial |
$4,442.88
|
| Rate for Payer: United Healthcare All Payer |
$4,072.64
|
|
|
CHOLECALCIFEROL(VIT D3) 5000
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 50268086615
|
| Hospital Charge Code |
25000417
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| 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 |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| 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 |
$1.34 |
| 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 |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
CHOLECYSTECTOMY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 47600
|
| Hospital Charge Code |
76101967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
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 |
$1,511.89 |
| Rate for Payer: Aetna Commercial |
$1,511.89
|
| Rate for Payer: Ambetter Exchange |
$1,022.08
|
| Rate for Payer: Anthem Medicaid |
$553.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,022.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,022.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,226.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,022.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.83
|
| 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 |
$1,328.70
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$559.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,022.08
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 47600
|
| Hospital Charge Code |
76101967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
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 |
$1,511.89 |
| Rate for Payer: Aetna Commercial |
$1,511.89
|
| Rate for Payer: Ambetter Exchange |
$1,022.08
|
| Rate for Payer: Anthem Medicaid |
$553.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,022.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,022.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,226.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,022.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.83
|
| 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 |
$1,328.70
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$559.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,022.08
|
|
|
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 |
$1,408.88 |
| Rate for Payer: Aetna Commercial |
$1,408.88
|
| Rate for Payer: Ambetter Exchange |
$1,075.32
|
| Rate for Payer: Anthem Medicaid |
$599.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,075.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,290.38
|
| 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 |
$1,188.13
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,075.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.32
|
| 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 |
$1,397.92
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$605.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,075.32
|
|
|
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 |
$1,408.88 |
| Rate for Payer: Aetna Commercial |
$1,408.88
|
| Rate for Payer: Ambetter Exchange |
$1,075.32
|
| Rate for Payer: Anthem Medicaid |
$599.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,075.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,290.38
|
| 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 |
$1,188.13
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,075.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.32
|
| 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 |
$1,397.92
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$605.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,075.32
|
|
|
CHOLECYSTECTOMY; WITH CHOLANGI
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 47605
|
| Hospital Charge Code |
76101968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
CHOLECYSTECTOMY; WITH CHOLANGI
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 47605
|
| Hospital Charge Code |
76101968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
CHOLECYSTOSTOMY W/IMAG
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 47490
|
| Hospital Charge Code |
76101955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| 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: 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 |
$285.00
|
| 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 |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
CHOLECYSTOSTOMY W/IMAG
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 47490
|
| Hospital Charge Code |
76101955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.70 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| 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 |
$3,260.78
|
| 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 |
$3,912.94
|
| 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 |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
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 |
$794.55 |
| Rate for Payer: Aetna Commercial |
$794.55
|
| Rate for Payer: Ambetter Exchange |
$306.48
|
| Rate for Payer: Anthem Medicaid |
$282.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$306.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$306.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$367.78
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$306.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$306.48
|
| 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 |
$398.42
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$306.48
|
|
|
CHOLECYSTOSTOMY W/IMAG(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 47490
|
| Hospital Charge Code |
761P1955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.22 |
| Max. Negotiated Rate |
$794.55 |
| Rate for Payer: Aetna Commercial |
$794.55
|
| Rate for Payer: Ambetter Exchange |
$306.48
|
| Rate for Payer: Anthem Medicaid |
$282.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$306.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$306.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$367.78
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$306.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$306.48
|
| 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 |
$398.42
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$306.48
|
|
|
CHOLESTEROL
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
30000280
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$9.68
|
| Rate for Payer: Ambetter Exchange |
$4.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Healthspan PPO |
$4.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.35
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.66
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.35
|
|
|
CHOLESTEROL
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
30000280
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$4.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.35
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$4.35
|
| Rate for Payer: Humana Medicare Advantage |
$4.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
CHOLESTEROL
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
30000280
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
CHONDRAL DART 18MM
|
Facility
|
IP
|
$4,382.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,314.66 |
| Max. Negotiated Rate |
$4,206.90 |
| Rate for Payer: Aetna Commercial |
$3,374.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,418.11
|
| Rate for Payer: Cash Price |
$2,191.09
|
| Rate for Payer: Cigna Commercial |
$3,637.22
|
| Rate for Payer: First Health Commercial |
$4,163.08
|
| Rate for Payer: Humana Commercial |
$3,724.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,234.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.33
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,505.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,812.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.71
|
| Rate for Payer: PHCS Commercial |
$4,206.90
|
| Rate for Payer: United Healthcare All Payer |
$3,856.33
|
|
