|
LAPAROSCOPE PROC APP
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 44979
|
| Hospital Charge Code |
76101873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
|
|
LAPAROSCOPE PROC APP
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 44979
|
| Hospital Charge Code |
76101873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.25
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
LAPAROSCOPE PROC APP
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 44979
|
| Hospital Charge Code |
76101873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem Medicaid |
$94.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| 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 |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Humana KY Medicaid |
$94.57
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$95.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.25
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
LAPAROSCOPE PROC APP(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 44979
|
| Hospital Charge Code |
761P1873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
|
|
LAPAROSCOPE PROC BLA
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
76102080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
LAPAROSCOPE PROC BLA
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
76102080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
LAPAROSCOPE PROC BLA
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
76102080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
LAPAROSCOPE PROC BLA(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
761P2080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
LAPAROSCOPE PROCEDURE LIVER
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47379
|
| Hospital Charge Code |
76101953
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| 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 |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LAPAROSCOPE PROCEDURE LIVER
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47379
|
| Hospital Charge Code |
76101953
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,600.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,520.00
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
|
|
LAPAROSCOPE PROCEDURE LIVER
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47379
|
| Hospital Charge Code |
76101953
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LAPAROSCOPE PROCEDURE LIVER(P
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47379
|
| Hospital Charge Code |
761P1953
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,600.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,520.00
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
|
|
LAPAROSCOPE PROC ESOPH
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 43289
|
| Hospital Charge Code |
76101768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,225.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,225.00
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$735.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$857.50
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
|
|
LAPAROSCOPE PROC ESOPH
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 43289
|
| Hospital Charge Code |
76101768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.25 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.75
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
LAPAROSCOPE PROC ESOPH
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 43289
|
| Hospital Charge Code |
76101768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.25 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem Medicaid |
$421.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| 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 |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Humana KY Medicaid |
$421.28
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$425.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$429.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.75
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
LAPAROSCOPE PROC ESOPH(P
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 43289
|
| Hospital Charge Code |
761P1768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,225.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,225.00
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$735.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$857.50
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
|
|
LAPAROSCOPE PROC LYMPHATIC
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 38589
|
| Hospital Charge Code |
76101603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
|
|
LAPAROSCOPE PROC LYMPHATIC
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 38589
|
| Hospital Charge Code |
76101603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| 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 |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
LAPAROSCOPE PROC LYMPHATIC
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 38589
|
| Hospital Charge Code |
76101603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
LAPAROSCOPE PROC LYMPHATIC(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 38589
|
| Hospital Charge Code |
761P1603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
|
|
LAPAROSCOPE PROC STOM
|
Professional
|
Both
|
$937.50
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
76101789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$937.50
|
| Rate for Payer: Cash Price |
$468.75
|
| Rate for Payer: Cash Price |
$468.75
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$562.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$656.25
|
| Rate for Payer: UHCCP Medicaid |
$328.12
|
|
|
LAPAROSCOPIC 4 FUNC HANDSET
|
Facility
|
OP
|
$2,125.53
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.32 |
| Max. Negotiated Rate |
$2,040.51 |
| Rate for Payer: Aetna Commercial |
$1,636.66
|
| Rate for Payer: Anthem Medicaid |
$730.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.91
|
| Rate for Payer: Cash Price |
$1,062.77
|
| Rate for Payer: Cigna Commercial |
$1,764.19
|
| Rate for Payer: First Health Commercial |
$2,019.25
|
| Rate for Payer: Humana Commercial |
$1,806.70
|
| Rate for Payer: Humana KY Medicaid |
$730.97
|
| Rate for Payer: Kentucky WC Medicaid |
$738.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.91
|
| Rate for Payer: PHCS Commercial |
$2,040.51
|
| Rate for Payer: United Healthcare All Payer |
$1,870.47
|
|
|
LAPAROSCOPIC 4 FUNC HANDSET
|
Facility
|
IP
|
$2,125.53
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.32 |
| Max. Negotiated Rate |
$2,040.51 |
| Rate for Payer: Aetna Commercial |
$1,636.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.91
|
| Rate for Payer: Cash Price |
$1,062.77
|
| Rate for Payer: Cigna Commercial |
$1,764.19
|
| Rate for Payer: First Health Commercial |
$2,019.25
|
| Rate for Payer: Humana Commercial |
$1,806.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.91
|
| Rate for Payer: PHCS Commercial |
$2,040.51
|
| Rate for Payer: United Healthcare All Payer |
$1,870.47
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
76101872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.19 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$849.46
|
| Rate for Payer: Anthem Medicaid |
$395.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$787.77
|
| Rate for Payer: Healthspan PPO |
$716.36
|
| Rate for Payer: Humana Medicaid |
$395.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$757.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$403.09
|
| Rate for Payer: Molina Healthcare Passport |
$395.19
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$399.14
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
76101872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| 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 |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
