|
ERBE HYBRID KNIFE
|
Facility
|
IP
|
$12,224.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,589.15 |
| Max. Negotiated Rate |
$11,735.28 |
| Rate for Payer: Aetna Commercial |
$9,412.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,534.92
|
| Rate for Payer: Cash Price |
$6,112.12
|
| Rate for Payer: Cigna Commercial |
$10,146.13
|
| Rate for Payer: First Health Commercial |
$11,613.04
|
| Rate for Payer: Humana Commercial |
$10,390.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,023.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,021.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,667.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,757.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,168.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,444.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,589.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,789.52
|
| Rate for Payer: PHCS Commercial |
$11,735.28
|
| Rate for Payer: United Healthcare All Payer |
$10,757.34
|
|
|
ERBITUX 200MG/100ML VIAL
|
Facility
|
OP
|
$8,764.53
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
25003883
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.72 |
| Max. Negotiated Rate |
$8,413.95 |
| Rate for Payer: Aetna Commercial |
$6,748.69
|
| Rate for Payer: Anthem Medicaid |
$3,014.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$73.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,836.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$103.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$99.52
|
| Rate for Payer: Cash Price |
$4,382.26
|
| Rate for Payer: Cash Price |
$4,382.26
|
| Rate for Payer: Cigna Commercial |
$7,274.56
|
| Rate for Payer: First Health Commercial |
$8,326.30
|
| Rate for Payer: Humana Commercial |
$7,449.85
|
| Rate for Payer: Humana KY Medicaid |
$3,014.12
|
| Rate for Payer: Humana Medicare Advantage |
$73.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,044.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,186.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,468.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,074.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,712.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,573.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,752.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,139.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.00
|
| Rate for Payer: PHCS Commercial |
$8,413.95
|
| Rate for Payer: United Healthcare All Payer |
$7,712.79
|
|
|
ERBITUX 200MG/100ML VIAL
|
Facility
|
IP
|
$8,764.53
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
25003883
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,139.39 |
| Max. Negotiated Rate |
$8,413.95 |
| Rate for Payer: Aetna Commercial |
$6,748.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,836.33
|
| Rate for Payer: Cash Price |
$4,382.26
|
| Rate for Payer: Cigna Commercial |
$7,274.56
|
| Rate for Payer: First Health Commercial |
$8,326.30
|
| Rate for Payer: Humana Commercial |
$7,449.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,186.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,468.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,712.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,573.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,752.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,139.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.00
|
| Rate for Payer: PHCS Commercial |
$8,413.95
|
| Rate for Payer: United Healthcare All Payer |
$7,712.79
|
|
|
ERBITUX DS 10 MG/ 5 ML
|
Facility
|
OP
|
$4,382.29
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
25002582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.72 |
| Max. Negotiated Rate |
$4,207.00 |
| Rate for Payer: Aetna Commercial |
$3,374.36
|
| Rate for Payer: Anthem Medicaid |
$1,507.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$73.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,418.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$103.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$99.52
|
| Rate for Payer: Cash Price |
$2,191.14
|
| Rate for Payer: Cash Price |
$2,191.14
|
| Rate for Payer: Cigna Commercial |
$3,637.30
|
| Rate for Payer: First Health Commercial |
$4,163.18
|
| Rate for Payer: Humana Commercial |
$3,724.95
|
| Rate for Payer: Humana KY Medicaid |
$1,507.07
|
| Rate for Payer: Humana Medicare Advantage |
$73.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,522.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,234.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,537.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.51
|
| Rate for Payer: PHCS Commercial |
$4,207.00
|
| Rate for Payer: United Healthcare All Payer |
$3,856.42
|
|
|
ERBITUX DS 10 MG/ 5 ML
|
Facility
|
IP
|
$4,382.29
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
25002582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$569.70 |
| Max. Negotiated Rate |
$4,207.00 |
| Rate for Payer: Aetna Commercial |
$3,374.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,418.19
|
| Rate for Payer: Cash Price |
$2,191.14
|
| Rate for Payer: Cigna Commercial |
$3,637.30
|
| Rate for Payer: First Health Commercial |
$4,163.18
|
| Rate for Payer: Humana Commercial |
$3,724.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,234.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.51
|
| Rate for Payer: PHCS Commercial |
$4,207.00
|
| Rate for Payer: United Healthcare All Payer |
$3,856.42
|
|
|
ERCP DUCT STENT PLACEMENT
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 43274
|
| Hospital Charge Code |
76101759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Anthem Medicaid |
$388.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$799.74
|
| Rate for Payer: Healthspan PPO |
$663.74
|
| Rate for Payer: Humana Medicaid |
$388.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$627.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.37
|
| Rate for Payer: Molina Healthcare Passport |
$388.60
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$392.49
|
|
|
ERCP DUCT STENT PLACEMENT
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 43274
|
| Hospital Charge Code |
76101759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$6,899.82 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,928.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,899.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,653.39
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$4,928.44
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,914.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
ERCP DUCT STENT PLACEMENT
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 43274
|
| Hospital Charge Code |
76101759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
ERCP DUCT STENT PLACEMENT(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 43274
|
| Hospital Charge Code |
761P1759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Anthem Medicaid |
$388.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$799.74
|
| Rate for Payer: Healthspan PPO |
$663.74
|
| Rate for Payer: Humana Medicaid |
$388.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$627.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.37
|
| Rate for Payer: Molina Healthcare Passport |
$388.60
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$392.49
|
|
|
ERCP EA DUCT/AMPULLA DILATE
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 43277
|
| Hospital Charge Code |
76101762
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$4,636.52 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| 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 |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
| Rate for Payer: Kentucky WC Medicaid |
$286.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
ERCP EA DUCT/AMPULLA DILATE
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 43277
|
| Hospital Charge Code |
76101762
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Anthem Medicaid |
$322.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$663.34
|
| Rate for Payer: Healthspan PPO |
$550.46
|
| Rate for Payer: Humana Medicaid |
$322.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$520.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.72
|
| Rate for Payer: Molina Healthcare Passport |
$322.27
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.49
|
|
|
ERCP EA DUCT/AMPULLA DILATE
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 43277
|
| Hospital Charge Code |
76101762
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
ERCP EA DUCT/AMPULLA DILATE(P
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 43277
|
| Hospital Charge Code |
761P1762
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Anthem Medicaid |
$322.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$663.34
|
| Rate for Payer: Healthspan PPO |
$550.46
|
| Rate for Payer: Humana Medicaid |
$322.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$520.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.72
|
| Rate for Payer: Molina Healthcare Passport |
$322.27
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.49
|
|
|
ERCP LITHOTRIPSY CALCULI
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43265
|
| Hospital Charge Code |
76101755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
ERCP LITHOTRIPSY CALCULI
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43265
|
| Hospital Charge Code |
76101755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.99 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$885.65
|
| Rate for Payer: Anthem Medicaid |
$455.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$794.35
|
| Rate for Payer: Healthspan PPO |
$746.89
|
| Rate for Payer: Humana Medicaid |
$455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$756.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$465.11
|
| Rate for Payer: Molina Healthcare Passport |
$455.99
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$460.55
|
|
|
ERCP LITHOTRIPSY CALCULI
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43265
|
| Hospital Charge Code |
76101755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$6,899.82 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,928.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,899.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,653.39
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,928.44
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,914.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
ERCP LITHOTRIPSY CALCULI(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43265
|
| Hospital Charge Code |
761P1755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.99 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$885.65
|
| Rate for Payer: Anthem Medicaid |
$455.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$794.35
|
| Rate for Payer: Healthspan PPO |
$746.89
|
| Rate for Payer: Humana Medicaid |
$455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$756.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$465.11
|
| Rate for Payer: Molina Healthcare Passport |
$455.99
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$460.55
|
|
|
ERCP REMOVE DUCT CALCULI
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43264
|
| Hospital Charge Code |
76101754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$4,636.52 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| 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 |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
ERCP REMOVE DUCT CALCULI
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43264
|
| Hospital Charge Code |
76101754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.23 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$789.11
|
| Rate for Payer: Anthem Medicaid |
$515.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$708.22
|
| Rate for Payer: Healthspan PPO |
$665.47
|
| Rate for Payer: Humana Medicaid |
$515.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$674.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$525.53
|
| Rate for Payer: Molina Healthcare Passport |
$515.23
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$520.38
|
|
|
ERCP REMOVE DUCT CALCULI
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43264
|
| Hospital Charge Code |
76101754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
ERCP REMOVE DUCT CALCULI(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43264
|
| Hospital Charge Code |
761P1754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.23 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$789.11
|
| Rate for Payer: Anthem Medicaid |
$515.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$708.22
|
| Rate for Payer: Healthspan PPO |
$665.47
|
| Rate for Payer: Humana Medicaid |
$515.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$674.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$525.53
|
| Rate for Payer: Molina Healthcare Passport |
$515.23
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$520.38
|
|
|
ERCP REMOVE FORGN BODY DUCT
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 43275
|
| Hospital Charge Code |
76101760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$286.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
ERCP REMOVE FORGN BODY DUCT
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 43275
|
| Hospital Charge Code |
76101760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Anthem Medicaid |
$320.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$659.34
|
| Rate for Payer: Healthspan PPO |
$547.20
|
| Rate for Payer: Humana Medicaid |
$320.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$517.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.72
|
| Rate for Payer: Molina Healthcare Passport |
$320.31
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.51
|
|
|
ERCP REMOVE FORGN BODY DUCT
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 43275
|
| Hospital Charge Code |
76101760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
ERCP REMOVE FORGN BODY DUCT(P
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 43275
|
| Hospital Charge Code |
761P1760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Anthem Medicaid |
$320.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$659.34
|
| Rate for Payer: Healthspan PPO |
$547.20
|
| Rate for Payer: Humana Medicaid |
$320.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$517.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.72
|
| Rate for Payer: Molina Healthcare Passport |
$320.31
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.51
|
|
