|
ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$2,057.21
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
76102199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.44 |
| Max. Negotiated Rate |
$1,974.92 |
| Rate for Payer: Aetna Commercial |
$1,584.05
|
| Rate for Payer: Anthem Medicaid |
$707.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$695.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$973.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$938.51
|
| Rate for Payer: Cash Price |
$1,028.61
|
| Rate for Payer: Cash Price |
$1,028.61
|
| Rate for Payer: Cigna Commercial |
$1,707.48
|
| Rate for Payer: First Health Commercial |
$1,954.35
|
| Rate for Payer: Humana Commercial |
$1,748.63
|
| Rate for Payer: Humana KY Medicaid |
$707.47
|
| Rate for Payer: Humana Medicare Advantage |
$695.19
|
| Rate for Payer: Kentucky WC Medicaid |
$714.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$834.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.74
|
| Rate for Payer: PHCS Commercial |
$1,974.92
|
| Rate for Payer: United Healthcare All Payer |
$1,810.34
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$2,057.21
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
76102199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.44 |
| Max. Negotiated Rate |
$1,974.92 |
| Rate for Payer: Aetna Commercial |
$1,584.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.62
|
| Rate for Payer: Cash Price |
$1,028.61
|
| Rate for Payer: Cigna Commercial |
$1,707.48
|
| Rate for Payer: First Health Commercial |
$1,954.35
|
| Rate for Payer: Humana Commercial |
$1,748.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.74
|
| Rate for Payer: PHCS Commercial |
$1,974.92
|
| Rate for Payer: United Healthcare All Payer |
$1,810.34
|
|
|
ENDOCERVICAL CURETTAGE(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
761P2199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.59 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$134.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.58
|
| Rate for Payer: Anthem Medicaid |
$43.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$151.49
|
| Rate for Payer: Healthspan PPO |
$144.97
|
| Rate for Payer: Humana Medicaid |
$43.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.46
|
| Rate for Payer: Molina Healthcare Passport |
$43.59
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$59.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.03
|
|
|
ENDOCERVICAL CURETTAGE(T
|
Facility
|
OP
|
$1,707.21
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
761T2199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.94 |
| Max. Negotiated Rate |
$1,638.92 |
| Rate for Payer: Aetna Commercial |
$1,314.55
|
| Rate for Payer: Anthem Medicaid |
$587.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$695.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,331.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$973.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$938.51
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cigna Commercial |
$1,416.98
|
| Rate for Payer: First Health Commercial |
$1,621.85
|
| Rate for Payer: Humana Commercial |
$1,451.13
|
| Rate for Payer: Humana KY Medicaid |
$587.11
|
| Rate for Payer: Humana Medicare Advantage |
$695.19
|
| Rate for Payer: Kentucky WC Medicaid |
$593.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,399.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$834.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,502.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,280.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.24
|
| Rate for Payer: PHCS Commercial |
$1,638.92
|
| Rate for Payer: United Healthcare All Payer |
$1,502.34
|
|
|
ENDOCERVICAL CURETTAGE(T
|
Facility
|
IP
|
$1,707.21
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
761T2199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.94 |
| Max. Negotiated Rate |
$1,638.92 |
| Rate for Payer: Aetna Commercial |
$1,314.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,331.62
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cigna Commercial |
$1,416.98
|
| Rate for Payer: First Health Commercial |
$1,621.85
|
| Rate for Payer: Humana Commercial |
$1,451.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,399.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$512.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,502.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,280.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.24
|
| Rate for Payer: PHCS Commercial |
$1,638.92
|
| Rate for Payer: United Healthcare All Payer |
$1,502.34
|
|
|
ENDO CHOLANGIOPANCREATOGRAPH
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
76101752
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$4,636.52 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,636.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,470.93
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Humana KY Medicaid |
$429.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
| Rate for Payer: Kentucky WC Medicaid |
$434.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
ENDO CHOLANGIOPANCREATOGRAPH
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 43262
|
| Hospital Charge Code |
76101753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.75 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$295.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$457.25
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
ENDO CHOLANGIOPANCREATOGRAPH
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
76101752
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
ENDO CHOLANGIOPANCREATOGRAPH
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
76101752
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.86 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$559.53
|
| Rate for Payer: Anthem Medicaid |
$353.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$502.39
|
| Rate for Payer: Healthspan PPO |
$471.87
|
| Rate for Payer: Humana Medicaid |
$353.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.94
|
| Rate for Payer: Molina Healthcare Passport |
$353.86
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$357.40
|
|
|
ENDO CHOLANGIOPANCREATOGRAPH
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 43262
|
| Hospital Charge Code |
76101753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.34 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna Commercial |
$657.18
|
| Rate for Payer: Anthem Medicaid |
$472.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,475.00
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$589.72
|
| Rate for Payer: Healthspan PPO |
$554.22
|
| Rate for Payer: Humana Medicaid |
$472.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$561.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$481.79
|
| Rate for Payer: Molina Healthcare Passport |
$472.34
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,032.50
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$477.06
|
|
|
ENDO CHOLANGIOPANCREATOGRAPH
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 43262
|
| Hospital Charge Code |
76101753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.75 |
| Max. Negotiated Rate |
$4,636.52 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem Medicaid |
$507.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,636.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,470.93
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Humana KY Medicaid |
$507.25
|
| Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
| Rate for Payer: Kentucky WC Medicaid |
$512.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$295.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$457.25
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
ENDO CHOLANGIOPANCREATOGRAP(P
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 43262
|
| Hospital Charge Code |
761P1753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.34 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna Commercial |
$657.18
|
| Rate for Payer: Anthem Medicaid |
$472.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,475.00
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$589.72
|
| Rate for Payer: Healthspan PPO |
$554.22
|
| Rate for Payer: Humana Medicaid |
$472.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$561.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$481.79
|
| Rate for Payer: Molina Healthcare Passport |
$472.34
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,032.50
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$477.06
|
|
|
ENDO CHOLANGIOPANCREATOGRAP(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
761P1752
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.86 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$559.53
|
| Rate for Payer: Anthem Medicaid |
$353.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$502.39
|
| Rate for Payer: Healthspan PPO |
$471.87
|
| Rate for Payer: Humana Medicaid |
$353.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.94
|
| Rate for Payer: Molina Healthcare Passport |
$353.86
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$357.40
|
|
|
ENDOCRINE DISORDERS WITH CC
|
Facility
|
IP
|
$12,419.99
|
|
|
Service Code
|
MSDRG 644
|
| Min. Negotiated Rate |
$8,427.85 |
| Max. Negotiated Rate |
$12,419.99 |
| Rate for Payer: Anthem Medicaid |
$8,427.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,871.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,419.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,976.42
|
| Rate for Payer: Humana KY Medicaid |
$8,427.85
|
| Rate for Payer: Humana Medicare Advantage |
$8,871.42
|
| Rate for Payer: Kentucky WC Medicaid |
$8,512.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,645.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,596.41
|
|
|
ENDOCRINE DISORDERS WITH MCC
|
Facility
|
IP
|
$19,244.72
|
|
|
Service Code
|
MSDRG 643
|
| Min. Negotiated Rate |
$13,058.92 |
| Max. Negotiated Rate |
$19,244.72 |
| Rate for Payer: Anthem Medicaid |
$13,058.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,746.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19,244.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,557.41
|
| Rate for Payer: Humana KY Medicaid |
$13,058.92
|
| Rate for Payer: Humana Medicare Advantage |
$13,746.23
|
| Rate for Payer: Kentucky WC Medicaid |
$13,189.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,495.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,320.10
|
|
|
ENDOCRINE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$8,901.17
|
|
|
Service Code
|
MSDRG 645
|
| Min. Negotiated Rate |
$6,040.08 |
| Max. Negotiated Rate |
$8,901.17 |
| Rate for Payer: Anthem Medicaid |
$6,040.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,357.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,901.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,583.27
|
| Rate for Payer: Humana KY Medicaid |
$6,040.08
|
| Rate for Payer: Humana Medicare Advantage |
$6,357.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,100.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,629.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,160.88
|
|
|
ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE
|
Facility
|
OP
|
$6,021.69
|
|
|
Service Code
|
CPT 58353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,301.21 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
|
|
ENDO MODEL MODULAR FMR LG LFT
|
Facility
|
IP
|
$32,496.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,224.51 |
| Max. Negotiated Rate |
$31,196.35 |
| Rate for Payer: Aetna Commercial |
$25,022.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,347.04
|
| Rate for Payer: Cash Price |
$16,248.10
|
| Rate for Payer: Cigna Commercial |
$26,971.85
|
| Rate for Payer: First Health Commercial |
$30,871.39
|
| Rate for Payer: Humana Commercial |
$27,621.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,646.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,982.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,748.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,596.66
|
| Rate for Payer: Ohio Health Group HMO |
$24,372.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,499.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,224.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,073.82
|
| Rate for Payer: PHCS Commercial |
$31,196.35
|
| Rate for Payer: United Healthcare All Payer |
$28,596.66
|
|
|
ENDO MODEL MODULAR FMR LG LFT
|
Facility
|
OP
|
$32,496.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,224.51 |
| Max. Negotiated Rate |
$31,196.35 |
| Rate for Payer: Aetna Commercial |
$25,022.07
|
| Rate for Payer: Anthem Medicaid |
$11,175.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,347.04
|
| Rate for Payer: Cash Price |
$16,248.10
|
| Rate for Payer: Cigna Commercial |
$26,971.85
|
| Rate for Payer: First Health Commercial |
$30,871.39
|
| Rate for Payer: Humana Commercial |
$27,621.77
|
| Rate for Payer: Humana KY Medicaid |
$11,175.44
|
| Rate for Payer: Kentucky WC Medicaid |
$11,289.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,646.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,982.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,748.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,399.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,596.66
|
| Rate for Payer: Ohio Health Group HMO |
$24,372.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,499.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,224.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,073.82
|
| Rate for Payer: PHCS Commercial |
$31,196.35
|
| Rate for Payer: United Healthcare All Payer |
$28,596.66
|
|
|
ENDO MODEL MODULAR STEM 200MM
|
Facility
|
IP
|
$12,768.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.85 |
| Max. Negotiated Rate |
$12,257.38 |
| Rate for Payer: Aetna Commercial |
$9,831.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,959.12
|
| Rate for Payer: Cash Price |
$6,384.05
|
| Rate for Payer: Cigna Commercial |
$10,597.52
|
| Rate for Payer: First Health Commercial |
$12,129.70
|
| Rate for Payer: Humana Commercial |
$10,852.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,469.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,422.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,830.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,235.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,576.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,553.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,958.11
|
| Rate for Payer: PHCS Commercial |
$12,257.38
|
| Rate for Payer: United Healthcare All Payer |
$11,235.93
|
|
|
ENDO MODEL MODULAR STEM 200MM
|
Facility
|
OP
|
$12,768.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.85 |
| Max. Negotiated Rate |
$12,257.38 |
| Rate for Payer: Aetna Commercial |
$9,831.44
|
| Rate for Payer: Anthem Medicaid |
$4,390.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,959.12
|
| Rate for Payer: Cash Price |
$6,384.05
|
| Rate for Payer: Cigna Commercial |
$10,597.52
|
| Rate for Payer: First Health Commercial |
$12,129.70
|
| Rate for Payer: Humana Commercial |
$10,852.88
|
| Rate for Payer: Humana KY Medicaid |
$4,390.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,435.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,469.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,422.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,830.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,479.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,235.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,576.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,553.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,958.11
|
| Rate for Payer: PHCS Commercial |
$12,257.38
|
| Rate for Payer: United Healthcare All Payer |
$11,235.93
|
|
|
ENDO MODEL MODULAR STEM 240MM
|
Facility
|
IP
|
$12,768.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.85 |
| Max. Negotiated Rate |
$12,257.38 |
| Rate for Payer: Aetna Commercial |
$9,831.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,959.12
|
| Rate for Payer: Cash Price |
$6,384.05
|
| Rate for Payer: Cigna Commercial |
$10,597.52
|
| Rate for Payer: First Health Commercial |
$12,129.70
|
| Rate for Payer: Humana Commercial |
$10,852.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,469.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,422.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,830.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,235.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,576.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,553.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,958.11
|
| Rate for Payer: PHCS Commercial |
$12,257.38
|
| Rate for Payer: United Healthcare All Payer |
$11,235.93
|
|
|
ENDO MODEL MODULAR STEM 240MM
|
Facility
|
OP
|
$12,768.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.85 |
| Max. Negotiated Rate |
$12,257.38 |
| Rate for Payer: Aetna Commercial |
$9,831.44
|
| Rate for Payer: Anthem Medicaid |
$4,390.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,959.12
|
| Rate for Payer: Cash Price |
$6,384.05
|
| Rate for Payer: Cigna Commercial |
$10,597.52
|
| Rate for Payer: First Health Commercial |
$12,129.70
|
| Rate for Payer: Humana Commercial |
$10,852.88
|
| Rate for Payer: Humana KY Medicaid |
$4,390.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,435.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,469.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,422.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,830.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,479.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,235.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,576.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,553.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,958.11
|
| Rate for Payer: PHCS Commercial |
$12,257.38
|
| Rate for Payer: United Healthcare All Payer |
$11,235.93
|
|
|
ENDO MODEL MODULAR TIB LG
|
Facility
|
IP
|
$18,430.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.00 |
| Max. Negotiated Rate |
$17,693.57 |
| Rate for Payer: Aetna Commercial |
$14,191.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,376.02
|
| Rate for Payer: Cash Price |
$9,215.40
|
| Rate for Payer: Cigna Commercial |
$15,297.56
|
| Rate for Payer: First Health Commercial |
$17,509.26
|
| Rate for Payer: Humana Commercial |
$15,666.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,113.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,601.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,529.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,219.10
|
| Rate for Payer: Ohio Health Group HMO |
$13,823.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,686.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,396.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,713.55
|
| Rate for Payer: PHCS Commercial |
$17,693.57
|
| Rate for Payer: United Healthcare All Payer |
$16,219.10
|
|
|
ENDO MODEL MODULAR TIB LG
|
Facility
|
OP
|
$18,430.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.00 |
| Max. Negotiated Rate |
$17,693.57 |
| Rate for Payer: Aetna Commercial |
$14,191.72
|
| Rate for Payer: Anthem Medicaid |
$6,338.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,376.02
|
| Rate for Payer: Cash Price |
$9,215.40
|
| Rate for Payer: Cigna Commercial |
$15,297.56
|
| Rate for Payer: First Health Commercial |
$17,509.26
|
| Rate for Payer: Humana Commercial |
$15,666.18
|
| Rate for Payer: Humana KY Medicaid |
$6,338.35
|
| Rate for Payer: Kentucky WC Medicaid |
$6,402.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,113.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,601.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,529.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,465.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,219.10
|
| Rate for Payer: Ohio Health Group HMO |
$13,823.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,686.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,396.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,713.55
|
| Rate for Payer: PHCS Commercial |
$17,693.57
|
| Rate for Payer: United Healthcare All Payer |
$16,219.10
|
|
