|
LANTERN MICROCATHETER 135 ST.
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
LANTUS (PER UNIT) SUB-Q
|
Facility
|
OP
|
$64.95
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna Commercial |
$50.01
|
| Rate for Payer: Anthem Medicaid |
$22.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.66
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cigna Commercial |
$53.91
|
| Rate for Payer: First Health Commercial |
$61.70
|
| Rate for Payer: Humana Commercial |
$55.21
|
| Rate for Payer: Humana KY Medicaid |
$22.34
|
| Rate for Payer: Kentucky WC Medicaid |
$22.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.16
|
| Rate for Payer: Ohio Health Group HMO |
$48.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.13
|
| Rate for Payer: PHCS Commercial |
$62.35
|
| Rate for Payer: United Healthcare All Payer |
$57.16
|
|
|
LANTUS (PER UNIT) SUB-Q
|
Facility
|
IP
|
$64.95
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna Commercial |
$50.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.66
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cigna Commercial |
$53.91
|
| Rate for Payer: First Health Commercial |
$61.70
|
| Rate for Payer: Humana Commercial |
$55.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.16
|
| Rate for Payer: Ohio Health Group HMO |
$48.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.13
|
| Rate for Payer: PHCS Commercial |
$62.35
|
| Rate for Payer: United Healthcare All Payer |
$57.16
|
|
|
LAPARO ABLATE RENAL CYST
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 50541
|
| Hospital Charge Code |
76102801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$187.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.85
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
|
LAPARO ABLATE RENAL CYST
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 50541
|
| Hospital Charge Code |
76102801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,505.11 |
| Rate for Payer: Aetna Commercial |
$1,505.11
|
| Rate for Payer: Anthem Medicaid |
$654.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$935.00
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$1,344.19
|
| Rate for Payer: Healthspan PPO |
$1,203.47
|
| Rate for Payer: Humana Medicaid |
$654.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,256.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$667.56
|
| Rate for Payer: Molina Healthcare Passport |
$654.47
|
| Rate for Payer: Multiplan PHCS |
$561.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$654.50
|
| Rate for Payer: UHCCP Medicaid |
$327.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$661.01
|
|
|
LAPARO ABLATE RENAL CYST
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 50541
|
| Hospital Charge Code |
76102801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$12,462.13 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem Medicaid |
$321.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,901.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,462.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,017.05
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Humana KY Medicaid |
$321.55
|
| Rate for Payer: Humana Medicare Advantage |
$8,901.52
|
| Rate for Payer: Kentucky WC Medicaid |
$324.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,681.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$328.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$187.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.85
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
|
LAPARO ABLATE RENAL MASS
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 50542
|
| Hospital Charge Code |
76102914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.50 |
| Max. Negotiated Rate |
$2,736.00 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$370.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
|
LAPARO ABLATE RENAL MASS
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 50542
|
| Hospital Charge Code |
76102914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.50 |
| Max. Negotiated Rate |
$12,462.13 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem Medicaid |
$980.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,901.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,462.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,017.05
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Humana KY Medicaid |
$980.12
|
| Rate for Payer: Humana Medicare Advantage |
$8,901.52
|
| Rate for Payer: Kentucky WC Medicaid |
$990.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,681.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$999.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$370.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
|
LAPARO ABLATE RENAL MASS
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 50542
|
| Hospital Charge Code |
76102914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.28 |
| Max. Negotiated Rate |
$2,850.00 |
| Rate for Payer: Aetna Commercial |
$1,907.78
|
| Rate for Payer: Anthem Medicaid |
$825.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,850.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$1,695.91
|
| Rate for Payer: Healthspan PPO |
$1,525.44
|
| Rate for Payer: Humana Medicaid |
$825.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,594.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$841.79
|
| Rate for Payer: Molina Healthcare Passport |
$825.28
|
| Rate for Payer: Multiplan PHCS |
$1,710.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,995.00
|
| Rate for Payer: UHCCP Medicaid |
$997.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$833.53
|
|
|
LAPARO DRAIN LYMPHOCELE
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49323
|
| Hospital Charge Code |
76101990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$924.46
|
| Rate for Payer: Anthem Medicaid |
$444.79
|
| 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 |
$856.20
|
| Rate for Payer: Healthspan PPO |
$779.61
|
| Rate for Payer: Humana Medicaid |
$444.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.69
|
| Rate for Payer: Molina Healthcare Passport |
$444.79
|
| 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 |
$449.24
|
|
|
LAPARO DRAIN LYMPHOCELE
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49323
|
| Hospital Charge Code |
76101990
|
|
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
|
|
|
LAPARO DRAIN LYMPHOCELE
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49323
|
| Hospital Charge Code |
76101990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| 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 |
$4,989.61
|
| 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 |
$5,987.53
|
| 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
|
|
|
LAPARO DRAIN LYMPHOCELE(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49323
|
| Hospital Charge Code |
761P1990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$924.46
|
| Rate for Payer: Anthem Medicaid |
$444.79
|
| 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 |
$856.20
|
| Rate for Payer: Healthspan PPO |
$779.61
|
| Rate for Payer: Humana Medicaid |
$444.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.69
|
| Rate for Payer: Molina Healthcare Passport |
$444.79
|
| 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 |
$449.24
|
|
|
LAPARO PROC ABDM/PER/OMENT
|
Professional
|
Both
|
$817.50
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76101993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$817.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$817.50
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$490.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$572.25
|
| Rate for Payer: UHCCP Medicaid |
$286.12
|
|
|
LAPARO PROC ABDM/PER/OMENT
|
Facility
|
IP
|
$817.50
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76101993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.28 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Aetna Commercial |
$629.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$637.65
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cigna Commercial |
$678.52
|
| Rate for Payer: First Health Commercial |
$776.62
|
| Rate for Payer: Humana Commercial |
$694.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$670.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$603.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$719.40
|
| Rate for Payer: Ohio Health Group HMO |
$613.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.42
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
LAPARO PROC ABDM/PER/OMENT
|
Facility
|
OP
|
$817.50
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76101993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.28 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$629.48
|
| Rate for Payer: Anthem Medicaid |
$281.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$637.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cigna Commercial |
$678.52
|
| Rate for Payer: First Health Commercial |
$776.62
|
| Rate for Payer: Humana Commercial |
$694.88
|
| Rate for Payer: Humana KY Medicaid |
$281.14
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$284.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$670.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$603.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$719.40
|
| Rate for Payer: Ohio Health Group HMO |
$613.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.42
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
LAPARO PROC ABDM/PER/OMENT(P
|
Professional
|
Both
|
$817.50
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
761P1993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$817.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$817.50
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$490.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$572.25
|
| Rate for Payer: UHCCP Medicaid |
$286.12
|
|
|
LAPARO PROC HERNIA REPAIR
|
Facility
|
IP
|
$2,650.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
76102040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$2,544.00 |
| Rate for Payer: Aetna Commercial |
$2,040.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,067.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cigna Commercial |
$2,199.50
|
| Rate for Payer: First Health Commercial |
$2,517.50
|
| Rate for Payer: Humana Commercial |
$2,252.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,173.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,955.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$795.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,332.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$344.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.50
|
| Rate for Payer: PHCS Commercial |
$2,544.00
|
| Rate for Payer: United Healthcare All Payer |
$2,332.00
|
|
|
LAPARO PROC HERNIA REPAIR
|
Facility
|
OP
|
$2,650.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
76102040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$2,040.50
|
| Rate for Payer: Anthem Medicaid |
$911.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,067.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cigna Commercial |
$2,199.50
|
| Rate for Payer: First Health Commercial |
$2,517.50
|
| Rate for Payer: Humana Commercial |
$2,252.50
|
| Rate for Payer: Humana KY Medicaid |
$911.34
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$920.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,173.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,955.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$929.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,332.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$344.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.50
|
| Rate for Payer: PHCS Commercial |
$2,544.00
|
| Rate for Payer: United Healthcare All Payer |
$2,332.00
|
|
|
LAPARO PROC HERNIA REPAIR
|
Professional
|
Both
|
$2,650.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
76102040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,650.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,650.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,590.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,855.00
|
| Rate for Payer: UHCCP Medicaid |
$927.50
|
|
|
LAPARO PROC HERNIA REPAIR(P
|
Professional
|
Both
|
$2,650.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
761P2040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,650.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,650.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,590.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,855.00
|
| Rate for Payer: UHCCP Medicaid |
$927.50
|
|
|
LAPARO RADICAL NEPHRECTOMY
|
Professional
|
Both
|
$2,925.00
|
|
|
Service Code
|
HCPCS 50545
|
| Hospital Charge Code |
76102052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$978.83 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Aetna Commercial |
$2,207.53
|
| Rate for Payer: Anthem Medicaid |
$978.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,925.00
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cigna Commercial |
$1,972.57
|
| Rate for Payer: Healthspan PPO |
$1,765.12
|
| Rate for Payer: Humana Medicaid |
$978.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,837.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$998.41
|
| Rate for Payer: Molina Healthcare Passport |
$978.83
|
| Rate for Payer: Multiplan PHCS |
$1,755.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,047.50
|
| Rate for Payer: UHCCP Medicaid |
$1,023.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$988.62
|
|
|
LAPARO RADICAL NEPHRECTOMY
|
Facility
|
IP
|
$2,925.00
|
|
|
Service Code
|
HCPCS 50545
|
| Hospital Charge Code |
76102052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.25 |
| Max. Negotiated Rate |
$2,808.00 |
| Rate for Payer: Aetna Commercial |
$2,252.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,281.50
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cigna Commercial |
$2,427.75
|
| Rate for Payer: First Health Commercial |
$2,778.75
|
| Rate for Payer: Humana Commercial |
$2,486.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,398.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,158.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$877.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,574.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,193.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$906.75
|
| Rate for Payer: PHCS Commercial |
$2,808.00
|
| Rate for Payer: United Healthcare All Payer |
$2,574.00
|
|
|
LAPARO RADICAL NEPHRECTOMY
|
Facility
|
OP
|
$2,925.00
|
|
|
Service Code
|
HCPCS 50545
|
| Hospital Charge Code |
76102052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.25 |
| Max. Negotiated Rate |
$2,808.00 |
| Rate for Payer: Aetna Commercial |
$2,252.25
|
| Rate for Payer: Anthem Medicaid |
$1,005.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,281.50
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cigna Commercial |
$2,427.75
|
| Rate for Payer: First Health Commercial |
$2,778.75
|
| Rate for Payer: Humana Commercial |
$2,486.25
|
| Rate for Payer: Humana KY Medicaid |
$1,005.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,016.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,398.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,158.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$877.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,026.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,574.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,193.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$906.75
|
| Rate for Payer: PHCS Commercial |
$2,808.00
|
| Rate for Payer: United Healthcare All Payer |
$2,574.00
|
|
|
LAPARO RADICAL NEPHRECTOMY(P
|
Professional
|
Both
|
$2,925.00
|
|
|
Service Code
|
HCPCS 50545
|
| Hospital Charge Code |
761P2052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$978.83 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Aetna Commercial |
$2,207.53
|
| Rate for Payer: Anthem Medicaid |
$978.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,925.00
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cigna Commercial |
$1,972.57
|
| Rate for Payer: Healthspan PPO |
$1,765.12
|
| Rate for Payer: Humana Medicaid |
$978.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,837.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$998.41
|
| Rate for Payer: Molina Healthcare Passport |
$978.83
|
| Rate for Payer: Multiplan PHCS |
$1,755.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,047.50
|
| Rate for Payer: UHCCP Medicaid |
$1,023.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$988.62
|
|
