|
ERCP EA DUCT/AMPULLA DILATE
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 43277
|
| Hospital Charge Code |
76101762
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$4,921.43 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,515.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| 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 |
$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 |
$3,515.31
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| 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 |
$4,218.37
|
| 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 |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| 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 |
$663.34 |
| Rate for Payer: Ambetter Exchange |
$351.62
|
| Rate for Payer: Anthem Medicaid |
$322.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$351.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$351.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.62
|
| 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 |
$457.11
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$351.62
|
|
|
ERCP LITHOTRIPSY CALCULI
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43265
|
| Hospital Charge Code |
76101755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$401.54 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$885.65
|
| Rate for Payer: Ambetter Exchange |
$401.54
|
| Rate for Payer: Anthem Medicaid |
$455.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$401.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$401.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.85
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$401.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.54
|
| 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 |
$522.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$460.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$401.54
|
|
|
ERCP LITHOTRIPSY CALCULI
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43265
|
| Hospital Charge Code |
76101755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| 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 |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
ERCP LITHOTRIPSY CALCULI
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43265
|
| Hospital Charge Code |
76101755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.63 |
| Max. Negotiated Rate |
$7,700.39 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,500.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,700.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,425.38
|
| 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 |
$5,500.28
|
| 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 |
$6,600.34
|
| 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 |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| 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 |
$401.54 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$885.65
|
| Rate for Payer: Ambetter Exchange |
$401.54
|
| Rate for Payer: Anthem Medicaid |
$455.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$401.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$401.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.85
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$401.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.54
|
| 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 |
$522.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$460.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$401.54
|
|
|
ERCP REMOVE DUCT CALCULI
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43264
|
| Hospital Charge Code |
76101754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.69 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$789.11
|
| Rate for Payer: Ambetter Exchange |
$338.69
|
| Rate for Payer: Anthem Medicaid |
$515.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$338.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$338.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$406.43
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.69
|
| 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 |
$440.30
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$520.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$338.69
|
|
|
ERCP REMOVE DUCT CALCULI
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43264
|
| Hospital Charge Code |
76101754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.63 |
| Max. Negotiated Rate |
$4,921.43 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,515.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| 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 |
$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 |
$3,515.31
|
| 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 |
$4,218.37
|
| 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 |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
ERCP REMOVE DUCT CALCULI
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 43264
|
| Hospital Charge Code |
76101754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| 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 |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| 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 |
$338.69 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$789.11
|
| Rate for Payer: Ambetter Exchange |
$338.69
|
| Rate for Payer: Anthem Medicaid |
$515.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$338.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$338.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$406.43
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.69
|
| 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 |
$440.30
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$520.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$338.69
|
|
|
ERCP REMOVE FORGN BODY DUCT
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 43275
|
| Hospital Charge Code |
76101760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.50 |
| 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 |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| 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 |
$659.34 |
| Rate for Payer: Ambetter Exchange |
$349.74
|
| Rate for Payer: Anthem Medicaid |
$320.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$349.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$349.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$419.69
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$349.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.74
|
| 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 |
$454.66
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$349.74
|
|
|
ERCP REMOVE FORGN BODY DUCT
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 43275
|
| Hospital Charge Code |
76101760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| 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 |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| 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 |
$2,103.34
|
| 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 |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| 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 |
$659.34 |
| Rate for Payer: Ambetter Exchange |
$349.74
|
| Rate for Payer: Anthem Medicaid |
$320.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$349.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$349.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$419.69
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$349.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.74
|
| 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 |
$454.66
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$349.74
|
|
|
ERCP STENT EXCHANGE W/DILATE
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 43276
|
| Hospital Charge Code |
76101761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.75 |
| Max. Negotiated Rate |
$832.00 |
| Rate for Payer: Ambetter Exchange |
$447.07
|
| Rate for Payer: Anthem Medicaid |
$404.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$447.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$447.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$536.48
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$832.00
|
| Rate for Payer: Healthspan PPO |
$690.44
|
| Rate for Payer: Humana Medicaid |
$404.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$652.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$447.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$412.43
|
| Rate for Payer: Molina Healthcare Passport |
$404.34
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$581.19
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$408.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$447.07
|
|
|
ERCP STENT EXCHANGE W/DILATE
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 43276
|
| Hospital Charge Code |
76101761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$7,700.39 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem Medicaid |
$352.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,500.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,700.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,425.38
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Humana KY Medicaid |
$352.50
|
| Rate for Payer: Humana Medicare Advantage |
$5,500.28
|
| Rate for Payer: Kentucky WC Medicaid |
$356.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,600.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.25
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
ERCP STENT EXCHANGE W/DILATE
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 43276
|
| Hospital Charge Code |
76101761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.50 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.25
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
ERCP STENT EXCHANGE W/DILAT(P
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 43276
|
| Hospital Charge Code |
761P1761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.75 |
| Max. Negotiated Rate |
$832.00 |
| Rate for Payer: Ambetter Exchange |
$447.07
|
| Rate for Payer: Anthem Medicaid |
$404.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$447.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$447.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$536.48
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$832.00
|
| Rate for Payer: Healthspan PPO |
$690.44
|
| Rate for Payer: Humana Medicaid |
$404.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$652.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$447.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$412.43
|
| Rate for Payer: Molina Healthcare Passport |
$404.34
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$581.19
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$408.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$447.07
|
|
|
ERCP W/SPECIMEN COLLECTION
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
76101751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$419.56 |
| Max. Negotiated Rate |
$4,921.43 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem Medicaid |
$419.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,515.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| 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 |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Humana KY Medicaid |
$419.56
|
| Rate for Payer: Humana Medicare Advantage |
$3,515.31
|
| Rate for Payer: Kentucky WC Medicaid |
$423.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,218.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.80
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
ERCP W/SPECIMEN COLLECTION
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
76101751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$1,171.20 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.80
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
ERCP W/SPECIMEN COLLECTION
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
76101751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.80 |
| Max. Negotiated Rate |
$732.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Ambetter Exchange |
$299.80
|
| Rate for Payer: Anthem Medicaid |
$344.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$299.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$299.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$359.76
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$477.54
|
| Rate for Payer: Healthspan PPO |
$448.65
|
| Rate for Payer: Humana Medicaid |
$344.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$454.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$299.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$299.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$351.66
|
| Rate for Payer: Molina Healthcare Passport |
$344.76
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$389.74
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$348.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$299.80
|
|
|
ERCP W/SPECIMEN COLLECTION(P
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
761P1751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.80 |
| Max. Negotiated Rate |
$732.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Ambetter Exchange |
$299.80
|
| Rate for Payer: Anthem Medicaid |
$344.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$299.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$299.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$359.76
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$477.54
|
| Rate for Payer: Healthspan PPO |
$448.65
|
| Rate for Payer: Humana Medicaid |
$344.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$454.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$299.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$299.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$351.66
|
| Rate for Payer: Molina Healthcare Passport |
$344.76
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$389.74
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$348.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$299.80
|
|
|
ERGONOVINE PROV TEST
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS 93024
|
| Hospital Charge Code |
48000071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$71.88 |
| Max. Negotiated Rate |
$516.18 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem Medicaid |
$71.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Humana KY Medicaid |
$71.88
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$72.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.21
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
ERGONOVINE PROV TEST
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS 93024
|
| Hospital Charge Code |
48000071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.21
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
ER INP ROOM RATE
|
Facility
|
IP
|
$1,790.00
|
|
| Hospital Charge Code |
11000006
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
