|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
76101872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| 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: 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 |
$570.00
|
| 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
|
|
|
LAPAROSCOPIC APPENDECTOMY(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
761P1872
|
|
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 BLDDER INJ REPAIR
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| 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 |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
LAPAROSCOPIC BLDDER INJ REPAIR
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
|
|
LAPAROSCOPIC BLDDER INJ REPAIR
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$19,123.05
|
|
|
Service Code
|
MSDRG 418
|
| Min. Negotiated Rate |
$12,976.35 |
| Max. Negotiated Rate |
$19,123.05 |
| Rate for Payer: Anthem Medicaid |
$12,976.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,659.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19,123.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,440.08
|
| Rate for Payer: Humana KY Medicaid |
$12,976.35
|
| Rate for Payer: Humana Medicare Advantage |
$13,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$13,106.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,391.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,235.88
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$27,114.09
|
|
|
Service Code
|
MSDRG 417
|
| Min. Negotiated Rate |
$18,398.85 |
| Max. Negotiated Rate |
$27,114.09 |
| Rate for Payer: Anthem Medicaid |
$18,398.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19,367.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27,114.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$26,145.73
|
| Rate for Payer: Humana KY Medicaid |
$18,398.85
|
| Rate for Payer: Humana Medicare Advantage |
$19,367.21
|
| Rate for Payer: Kentucky WC Medicaid |
$18,582.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,240.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,766.83
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$15,362.09
|
|
|
Service Code
|
MSDRG 419
|
| Min. Negotiated Rate |
$10,424.27 |
| Max. Negotiated Rate |
$15,362.09 |
| Rate for Payer: Anthem Medicaid |
$10,424.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,972.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,362.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,813.44
|
| Rate for Payer: Humana KY Medicaid |
$10,424.27
|
| Rate for Payer: Humana Medicare Advantage |
$10,972.92
|
| Rate for Payer: Kentucky WC Medicaid |
$10,528.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,167.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,632.76
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
761P1973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Facility
|
IP
|
$3,772.14
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
761T1973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.38 |
| Max. Negotiated Rate |
$3,621.25 |
| Rate for Payer: Aetna Commercial |
$2,904.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,942.27
|
| Rate for Payer: Cash Price |
$1,886.07
|
| Rate for Payer: Cigna Commercial |
$3,130.88
|
| Rate for Payer: First Health Commercial |
$3,583.53
|
| Rate for Payer: Humana Commercial |
$3,206.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,093.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,783.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,131.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,319.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,829.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$754.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.36
|
| Rate for Payer: PHCS Commercial |
$3,621.25
|
| Rate for Payer: United Healthcare All Payer |
$3,319.48
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Facility
|
OP
|
$3,772.14
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
761T1973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.38 |
| Max. Negotiated Rate |
$3,621.25 |
| Rate for Payer: Aetna Commercial |
$2,904.55
|
| Rate for Payer: Anthem Medicaid |
$1,297.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,942.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,886.07
|
| Rate for Payer: Cash Price |
$1,886.07
|
| Rate for Payer: Cigna Commercial |
$3,130.88
|
| Rate for Payer: First Health Commercial |
$3,583.53
|
| Rate for Payer: Humana Commercial |
$3,206.32
|
| Rate for Payer: Humana KY Medicaid |
$1,297.24
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,310.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,093.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,783.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,323.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,319.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,829.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$754.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.36
|
| Rate for Payer: PHCS Commercial |
$3,621.25
|
| Rate for Payer: United Healthcare All Payer |
$3,319.48
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Facility
|
IP
|
$5,022.14
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
76101973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$652.88 |
| Max. Negotiated Rate |
$4,821.25 |
| Rate for Payer: Aetna Commercial |
$3,867.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,917.27
|
| Rate for Payer: Cash Price |
$2,511.07
|
| Rate for Payer: Cigna Commercial |
$4,168.38
|
| Rate for Payer: First Health Commercial |
$4,771.03
|
| Rate for Payer: Humana Commercial |
$4,268.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,118.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,706.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,419.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,766.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,556.86
|
| Rate for Payer: PHCS Commercial |
$4,821.25
|
| Rate for Payer: United Healthcare All Payer |
$4,419.48
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Professional
|
Both
|
$5,022.14
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
76101973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$5,022.14 |
| Rate for Payer: Buckeye Medicare Advantage |
$5,022.14
|
| Rate for Payer: Cash Price |
$2,511.07
|
| Rate for Payer: Cash Price |
$2,511.07
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$3,013.28
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,515.50
|
| Rate for Payer: UHCCP Medicaid |
$1,757.75
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Facility
|
OP
|
$5,022.14
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
76101973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$608.42 |
| Max. Negotiated Rate |
$4,821.25 |
| Rate for Payer: Aetna Commercial |
$3,867.05
|
| Rate for Payer: Anthem Medicaid |
$1,727.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,917.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$2,511.07
|
| Rate for Payer: Cash Price |
$2,511.07
|
| Rate for Payer: Cigna Commercial |
$4,168.38
|
| Rate for Payer: First Health Commercial |
$4,771.03
|
| Rate for Payer: Humana Commercial |
$4,268.82
|
| Rate for Payer: Humana KY Medicaid |
$1,727.11
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,744.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,118.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,706.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,761.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,419.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,766.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,556.86
|
| Rate for Payer: PHCS Commercial |
$4,821.25
|
| Rate for Payer: United Healthcare All Payer |
$4,419.48
|
|
|
LAPAROSCOPIC LYSIS ADHESIONS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58660
|
| Hospital Charge Code |
76102248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
LAPAROSCOPIC LYSIS ADHESIONS
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58660
|
| Hospital Charge Code |
76102248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.38 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,024.91
|
| Rate for Payer: Anthem Medicaid |
$497.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$997.11
|
| Rate for Payer: Healthspan PPO |
$992.37
|
| Rate for Payer: Humana Medicaid |
$497.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$875.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$507.33
|
| Rate for Payer: Molina Healthcare Passport |
$497.38
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$502.35
|
|
|
LAPAROSCOPIC LYSIS ADHESIONS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58660
|
| Hospital Charge Code |
76102248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| 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 |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
LAPAROSCOPIC LYSIS ADHESIONS(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58660
|
| Hospital Charge Code |
761P2248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.38 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,024.91
|
| Rate for Payer: Anthem Medicaid |
$497.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$997.11
|
| Rate for Payer: Healthspan PPO |
$992.37
|
| Rate for Payer: Humana Medicaid |
$497.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$875.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$507.33
|
| Rate for Payer: Molina Healthcare Passport |
$497.38
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$502.35
|
|
|
LAPAROSCOPIC PLICATION DIPHRGM
|
Facility
|
IP
|
$3,095.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
76101624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.35 |
| Max. Negotiated Rate |
$2,971.20 |
| Rate for Payer: Aetna Commercial |
$2,383.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,414.10
|
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Cigna Commercial |
$2,568.85
|
| Rate for Payer: First Health Commercial |
$2,940.25
|
| Rate for Payer: Humana Commercial |
$2,630.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,537.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,284.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,723.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,321.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$619.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.45
|
| Rate for Payer: PHCS Commercial |
$2,971.20
|
| Rate for Payer: United Healthcare All Payer |
$2,723.60
|
|
|
LAPAROSCOPIC PLICATION DIPHRGM
|
Professional
|
Both
|
$3,095.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
761P1624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,095.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,095.00
|
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,857.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,166.50
|
| Rate for Payer: UHCCP Medicaid |
$1,083.25
|
|
|
LAPAROSCOPIC PLICATION DIPHRGM
|
Professional
|
Both
|
$3,095.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
76101624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,095.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,095.00
|
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,857.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,166.50
|
| Rate for Payer: UHCCP Medicaid |
$1,083.25
|
|
|
LAPAROSCOPIC PLICATION DIPHRGM
|
Facility
|
OP
|
$3,095.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
76101624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.35 |
| Max. Negotiated Rate |
$2,971.20 |
| Rate for Payer: Aetna Commercial |
$2,383.15
|
| Rate for Payer: Anthem Medicaid |
$1,064.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,414.10
|
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Cigna Commercial |
$2,568.85
|
| Rate for Payer: First Health Commercial |
$2,940.25
|
| Rate for Payer: Humana Commercial |
$2,630.75
|
| Rate for Payer: Humana KY Medicaid |
$1,064.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,075.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,537.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,284.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,085.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,723.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,321.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$619.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.45
|
| Rate for Payer: PHCS Commercial |
$2,971.20
|
| Rate for Payer: United Healthcare All Payer |
$2,723.60
|
|
|
LAPAROSCOPIC REMOVAL OF IUD
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem Medicaid |
$426.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| 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 |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Humana KY Medicaid |
$426.44
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$430.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$384.40
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
LAPAROSCOPIC REMOVAL OF IUD
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,240.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$868.00
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
|
|
LAPAROSCOPIC REMOVAL OF IUD
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$1,190.40 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$384.40
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
