|
ENDOCERV CURETTAGE W/SCOPE
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
HCPCS 57456
|
| Hospital Charge Code |
76102196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$927.36 |
| Rate for Payer: Aetna Commercial |
$743.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$753.48
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cigna Commercial |
$801.78
|
| Rate for Payer: First Health Commercial |
$917.70
|
| Rate for Payer: Humana Commercial |
$821.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$289.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.08
|
| Rate for Payer: Ohio Health Group HMO |
$724.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$666.54
|
| Rate for Payer: PHCS Commercial |
$927.36
|
| Rate for Payer: United Healthcare All Payer |
$850.08
|
|
|
ENDOCERV CURETTAGE W/SCOPE
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
HCPCS 57456
|
| Hospital Charge Code |
76102196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.79 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna Commercial |
$159.92
|
| Rate for Payer: Ambetter Exchange |
$95.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.79
|
| Rate for Payer: Anthem Medicaid |
$104.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.20
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cigna Commercial |
$203.90
|
| Rate for Payer: Healthspan PPO |
$197.35
|
| Rate for Payer: Humana Medicaid |
$104.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.51
|
| Rate for Payer: Molina Healthcare Passport |
$104.42
|
| Rate for Payer: Multiplan PHCS |
$579.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$123.72
|
| Rate for Payer: UHCCP Medicaid |
$74.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.17
|
|
|
ENDOCERV CURETTAGE W/SCOPE
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
HCPCS 57456
|
| Hospital Charge Code |
76102196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$927.36 |
| Rate for Payer: Aetna Commercial |
$743.82
|
| Rate for Payer: Anthem Medicaid |
$332.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$753.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cigna Commercial |
$801.78
|
| Rate for Payer: First Health Commercial |
$917.70
|
| Rate for Payer: Humana Commercial |
$821.10
|
| Rate for Payer: Humana KY Medicaid |
$332.21
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$335.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$338.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.08
|
| Rate for Payer: Ohio Health Group HMO |
$724.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$666.54
|
| Rate for Payer: PHCS Commercial |
$927.36
|
| Rate for Payer: United Healthcare All Payer |
$850.08
|
|
|
ENDOCERV CURETTAGE W/SCOPE(P
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 57456
|
| Hospital Charge Code |
761P2196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.79 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna Commercial |
$159.92
|
| Rate for Payer: Ambetter Exchange |
$95.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.79
|
| Rate for Payer: Anthem Medicaid |
$104.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.20
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$203.90
|
| Rate for Payer: Healthspan PPO |
$197.35
|
| Rate for Payer: Humana Medicaid |
$104.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.51
|
| Rate for Payer: Molina Healthcare Passport |
$104.42
|
| Rate for Payer: Multiplan PHCS |
$234.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$123.72
|
| Rate for Payer: UHCCP Medicaid |
$74.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.17
|
|
|
ENDOCERV CURETTAGE W/SCOPE(T
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
HCPCS 57456
|
| Hospital Charge Code |
761T2196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.09 |
| Max. Negotiated Rate |
$552.96 |
| Rate for Payer: Aetna Commercial |
$443.52
|
| Rate for Payer: Anthem Medicaid |
$198.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$449.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$478.08
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: Humana Commercial |
$489.60
|
| Rate for Payer: Humana KY Medicaid |
$198.09
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$200.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$472.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$425.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$202.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.88
|
| Rate for Payer: Ohio Health Group HMO |
$432.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$397.44
|
| Rate for Payer: PHCS Commercial |
$552.96
|
| Rate for Payer: United Healthcare All Payer |
$506.88
|
|
|
ENDOCERV CURETTAGE W/SCOPE(T
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
HCPCS 57456
|
| Hospital Charge Code |
761T2196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$552.96 |
| Rate for Payer: Aetna Commercial |
$443.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$449.28
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$478.08
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: Humana Commercial |
$489.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$472.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$425.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.88
|
| Rate for Payer: Ohio Health Group HMO |
$432.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$397.44
|
| Rate for Payer: PHCS Commercial |
$552.96
|
| Rate for Payer: United Healthcare All Payer |
$506.88
|
|
|
ENDOCERVICAL CURETTAGE
|
Professional
|
Both
|
$2,058.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
76102199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$1,234.80 |
| Rate for Payer: Aetna Commercial |
$134.74
|
| Rate for Payer: Ambetter Exchange |
$101.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.58
|
| Rate for Payer: Anthem Medicaid |
$52.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.75
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$151.49
|
| Rate for Payer: Healthspan PPO |
$144.97
|
| Rate for Payer: Humana Medicaid |
$52.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.08
|
| Rate for Payer: Molina Healthcare Passport |
$52.04
|
| Rate for Payer: Multiplan PHCS |
$1,234.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.90
|
| Rate for Payer: UHCCP Medicaid |
$59.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.46
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$2,058.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
76102199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.40 |
| Max. Negotiated Rate |
$1,975.68 |
| Rate for Payer: Aetna Commercial |
$1,584.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,605.24
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,708.14
|
| Rate for Payer: First Health Commercial |
$1,955.10
|
| Rate for Payer: Humana Commercial |
$1,749.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,687.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,543.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,646.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,790.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,420.02
|
| Rate for Payer: PHCS Commercial |
$1,975.68
|
| Rate for Payer: United Healthcare All Payer |
$1,811.04
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$2,058.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
76102199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$707.75 |
| Max. Negotiated Rate |
$1,975.68 |
| Rate for Payer: Aetna Commercial |
$1,584.66
|
| Rate for Payer: Anthem Medicaid |
$707.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$804.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,605.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,126.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,086.14
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,708.14
|
| Rate for Payer: First Health Commercial |
$1,955.10
|
| Rate for Payer: Humana Commercial |
$1,749.30
|
| Rate for Payer: Humana KY Medicaid |
$707.75
|
| Rate for Payer: Humana Medicare Advantage |
$804.55
|
| Rate for Payer: Kentucky WC Medicaid |
$714.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,687.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,543.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,646.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,790.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,420.02
|
| Rate for Payer: PHCS Commercial |
$1,975.68
|
| Rate for Payer: United Healthcare All Payer |
$1,811.04
|
|
|
ENDOCERVICAL CURETTAGE(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
761P2199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$134.74
|
| Rate for Payer: Ambetter Exchange |
$101.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.58
|
| Rate for Payer: Anthem Medicaid |
$52.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.75
|
| 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 |
$52.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.08
|
| Rate for Payer: Molina Healthcare Passport |
$52.04
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.90
|
| Rate for Payer: UHCCP Medicaid |
$59.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.46
|
|
|
ENDOCERVICAL CURETTAGE(T
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
761T2199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$512.40 |
| Max. Negotiated Rate |
$1,639.68 |
| Rate for Payer: Aetna Commercial |
$1,315.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,332.24
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: Cigna Commercial |
$1,417.64
|
| Rate for Payer: First Health Commercial |
$1,622.60
|
| Rate for Payer: Humana Commercial |
$1,451.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,400.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,260.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$512.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,503.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,281.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,485.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.52
|
| Rate for Payer: PHCS Commercial |
$1,639.68
|
| Rate for Payer: United Healthcare All Payer |
$1,503.04
|
|
|
ENDOCERVICAL CURETTAGE(T
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
761T2199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$587.38 |
| Max. Negotiated Rate |
$1,639.68 |
| Rate for Payer: Aetna Commercial |
$1,315.16
|
| Rate for Payer: Anthem Medicaid |
$587.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$804.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,332.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,126.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,086.14
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: Cigna Commercial |
$1,417.64
|
| Rate for Payer: First Health Commercial |
$1,622.60
|
| Rate for Payer: Humana Commercial |
$1,451.80
|
| Rate for Payer: Humana KY Medicaid |
$587.38
|
| Rate for Payer: Humana Medicare Advantage |
$804.55
|
| Rate for Payer: Kentucky WC Medicaid |
$593.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,400.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,260.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$599.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,503.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,281.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,485.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.52
|
| Rate for Payer: PHCS Commercial |
$1,639.68
|
| Rate for Payer: United Healthcare All Payer |
$1,503.04
|
|
|
ENDO CHOLANGIOPANCREATOGRAPH
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 43262
|
| Hospital Charge Code |
76101753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.50 |
| 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 |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
ENDO CHOLANGIOPANCREATOGRAPH
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 43262
|
| Hospital Charge Code |
76101753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.71 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Aetna Commercial |
$657.18
|
| Rate for Payer: Ambetter Exchange |
$331.71
|
| Rate for Payer: Anthem Medicaid |
$472.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$331.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$331.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$398.05
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$331.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.71
|
| 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 |
$431.22
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$477.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$331.71
|
|
|
ENDO CHOLANGIOPANCREATOGRAPH
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
76101752
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.88 |
| Max. Negotiated Rate |
$4,921.43 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,515.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,921.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,745.67
|
| 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 |
$3,515.31
|
| 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 |
$4,218.37
|
| 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 |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
ENDO CHOLANGIOPANCREATOGRAPH
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 43262
|
| Hospital Charge Code |
76101753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.25 |
| Max. Negotiated Rate |
$4,921.43 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem Medicaid |
$507.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,515.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,921.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,745.67
|
| 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 |
$3,515.31
|
| Rate for Payer: Kentucky WC Medicaid |
$512.41
|
| 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 |
$4,218.37
|
| 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 |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| 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 |
$375.00 |
| 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 |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| 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 |
$314.34 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$559.53
|
| Rate for Payer: Ambetter Exchange |
$314.34
|
| Rate for Payer: Anthem Medicaid |
$353.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.21
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$314.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.34
|
| 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 |
$408.64
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$357.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.34
|
|
|
ENDO CHOLANGIOPANCREATOGRAP(P
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 43262
|
| Hospital Charge Code |
761P1753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.71 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Aetna Commercial |
$657.18
|
| Rate for Payer: Ambetter Exchange |
$331.71
|
| Rate for Payer: Anthem Medicaid |
$472.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$331.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$331.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$398.05
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$331.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.71
|
| 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 |
$431.22
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$477.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$331.71
|
|
|
ENDO CHOLANGIOPANCREATOGRAP(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
761P1752
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.34 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$559.53
|
| Rate for Payer: Ambetter Exchange |
$314.34
|
| Rate for Payer: Anthem Medicaid |
$353.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.21
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$314.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.34
|
| 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 |
$408.64
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$357.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.34
|
|
|
ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE
|
Facility
|
OP
|
$6,385.65
|
|
|
Service Code
|
CPT 58353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,561.18 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
|
|
ENDO MODEL MODULAR FMR LG LFT
|
Facility
|
IP
|
$33,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,036.50 |
| Max. Negotiated Rate |
$32,116.80 |
| Rate for Payer: Aetna Commercial |
$25,760.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,094.90
|
| Rate for Payer: Cash Price |
$16,727.50
|
| Rate for Payer: Cigna Commercial |
$27,767.65
|
| Rate for Payer: First Health Commercial |
$31,782.25
|
| Rate for Payer: Humana Commercial |
$28,436.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,433.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,689.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,036.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,440.40
|
| Rate for Payer: Ohio Health Group HMO |
$25,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,764.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,105.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,083.95
|
| Rate for Payer: PHCS Commercial |
$32,116.80
|
| Rate for Payer: United Healthcare All Payer |
$29,440.40
|
|
|
ENDO MODEL MODULAR FMR LG LFT
|
Facility
|
OP
|
$33,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,036.50 |
| Max. Negotiated Rate |
$32,116.80 |
| Rate for Payer: Aetna Commercial |
$25,760.35
|
| Rate for Payer: Anthem Medicaid |
$11,505.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,094.90
|
| Rate for Payer: Cash Price |
$16,727.50
|
| Rate for Payer: Cigna Commercial |
$27,767.65
|
| Rate for Payer: First Health Commercial |
$31,782.25
|
| Rate for Payer: Humana Commercial |
$28,436.75
|
| Rate for Payer: Humana KY Medicaid |
$11,505.17
|
| Rate for Payer: Kentucky WC Medicaid |
$11,622.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,433.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,689.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,036.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,736.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,440.40
|
| Rate for Payer: Ohio Health Group HMO |
$25,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,764.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,105.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,083.95
|
| Rate for Payer: PHCS Commercial |
$32,116.80
|
| Rate for Payer: United Healthcare All Payer |
$29,440.40
|
|
|
ENDO MODEL MODULAR STEM 200MM
|
Facility
|
IP
|
$13,019.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.99 |
| Max. Negotiated Rate |
$12,499.18 |
| Rate for Payer: Aetna Commercial |
$10,025.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,155.58
|
| Rate for Payer: Cash Price |
$6,509.99
|
| Rate for Payer: Cigna Commercial |
$10,806.58
|
| Rate for Payer: First Health Commercial |
$12,368.98
|
| Rate for Payer: Humana Commercial |
$11,066.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,676.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,608.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,905.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,457.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,764.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,415.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,327.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,983.79
|
| Rate for Payer: PHCS Commercial |
$12,499.18
|
| Rate for Payer: United Healthcare All Payer |
$11,457.58
|
|
|
ENDO MODEL MODULAR STEM 200MM
|
Facility
|
OP
|
$13,019.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.99 |
| Max. Negotiated Rate |
$12,499.18 |
| Rate for Payer: Aetna Commercial |
$10,025.38
|
| Rate for Payer: Anthem Medicaid |
$4,477.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,155.58
|
| Rate for Payer: Cash Price |
$6,509.99
|
| Rate for Payer: Cigna Commercial |
$10,806.58
|
| Rate for Payer: First Health Commercial |
$12,368.98
|
| Rate for Payer: Humana Commercial |
$11,066.98
|
| Rate for Payer: Humana KY Medicaid |
$4,477.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,523.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,676.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,608.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,905.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,567.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,457.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,764.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,415.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,327.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,983.79
|
| Rate for Payer: PHCS Commercial |
$12,499.18
|
| Rate for Payer: United Healthcare All Payer |
$11,457.58
|
|
