|
LAPAROSCOPY ENTEROLYSIS
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
76101824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,335.26 |
| Rate for Payer: Aetna Commercial |
$1,335.26
|
| Rate for Payer: Anthem Medicaid |
$635.24
|
| 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: Cigna Commercial |
$1,247.71
|
| Rate for Payer: Healthspan PPO |
$1,126.05
|
| Rate for Payer: Humana Medicaid |
$635.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,175.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$647.94
|
| Rate for Payer: Molina Healthcare Passport |
$635.24
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$641.59
|
|
|
LAPAROSCOPY ENTEROLYSIS
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
76101824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| 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 |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Humana KY Medicaid |
$429.88
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$434.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
LAPAROSCOPY ENTEROLYSIS(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
761P1824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,335.26 |
| Rate for Payer: Aetna Commercial |
$1,335.26
|
| Rate for Payer: Anthem Medicaid |
$635.24
|
| 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: Cigna Commercial |
$1,247.71
|
| Rate for Payer: Healthspan PPO |
$1,126.05
|
| Rate for Payer: Humana Medicaid |
$635.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,175.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$647.94
|
| Rate for Payer: Molina Healthcare Passport |
$635.24
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$641.59
|
|
|
LAPAROSCOPY EXCIS TUMOR STOMAC
|
Facility
|
IP
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
76102802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$433.94 |
| Max. Negotiated Rate |
$3,204.48 |
| Rate for Payer: Aetna Commercial |
$2,570.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.64
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$2,770.54
|
| Rate for Payer: First Health Commercial |
$3,171.10
|
| Rate for Payer: Humana Commercial |
$2,837.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,737.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.78
|
| Rate for Payer: PHCS Commercial |
$3,204.48
|
| Rate for Payer: United Healthcare All Payer |
$2,937.44
|
|
|
LAPAROSCOPY EXCIS TUMOR STOMAC
|
Facility
|
OP
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
76102802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$433.94 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$2,570.26
|
| Rate for Payer: Anthem Medicaid |
$1,147.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.64
|
| 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 |
$1,669.00
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$2,770.54
|
| Rate for Payer: First Health Commercial |
$3,171.10
|
| Rate for Payer: Humana Commercial |
$2,837.30
|
| Rate for Payer: Humana KY Medicaid |
$1,147.94
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,159.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,737.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,170.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.78
|
| Rate for Payer: PHCS Commercial |
$3,204.48
|
| Rate for Payer: United Healthcare All Payer |
$2,937.44
|
|
|
LAPAROSCOPY EXCIS TUMOR STOMAC
|
Professional
|
Both
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
76102802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,338.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,338.00
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,002.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,336.60
|
| Rate for Payer: UHCCP Medicaid |
$1,168.30
|
|
|
LAPAROSCOPY GASTROSTOMY
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 43653
|
| Hospital Charge Code |
76101788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
LAPAROSCOPY GASTROSTOMY
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 43653
|
| Hospital Charge Code |
76101788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.37 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$794.92
|
| Rate for Payer: Anthem Medicaid |
$384.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$735.64
|
| Rate for Payer: Healthspan PPO |
$670.37
|
| Rate for Payer: Humana Medicaid |
$384.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$716.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.06
|
| Rate for Payer: Molina Healthcare Passport |
$384.37
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$388.21
|
|
|
LAPAROSCOPY GASTROSTOMY
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 43653
|
| Hospital Charge Code |
76101788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
LAPAROSCOPY GASTROSTOMY(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 43653
|
| Hospital Charge Code |
761P1788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.37 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$794.92
|
| Rate for Payer: Anthem Medicaid |
$384.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$735.64
|
| Rate for Payer: Healthspan PPO |
$670.37
|
| Rate for Payer: Humana Medicaid |
$384.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$716.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.06
|
| Rate for Payer: Molina Healthcare Passport |
$384.37
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$388.21
|
|
|
LAPAROSCOPY LYMPH NODE BIOP
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
76101602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.10
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
LAPAROSCOPY LYMPH NODE BIOP
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
76101602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem Medicaid |
$312.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| 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 |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Humana KY Medicaid |
$312.95
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$316.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.10
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
LAPAROSCOPY LYMPH NODE BIOP
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
76101602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Aetna Commercial |
$842.56
|
| Rate for Payer: Anthem Medicaid |
$434.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$910.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$776.49
|
| Rate for Payer: Healthspan PPO |
$673.70
|
| Rate for Payer: Humana Medicaid |
$434.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$692.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$443.15
|
| Rate for Payer: Molina Healthcare Passport |
$434.46
|
| Rate for Payer: Multiplan PHCS |
$546.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$637.00
|
| Rate for Payer: UHCCP Medicaid |
$318.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$438.80
|
|
|
LAPAROSCOPY LYMPH NODE BIOP(P
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
761P1602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Aetna Commercial |
$842.56
|
| Rate for Payer: Anthem Medicaid |
$434.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$910.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$776.49
|
| Rate for Payer: Healthspan PPO |
$673.70
|
| Rate for Payer: Humana Medicaid |
$434.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$692.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$443.15
|
| Rate for Payer: Molina Healthcare Passport |
$434.46
|
| Rate for Payer: Multiplan PHCS |
$546.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$637.00
|
| Rate for Payer: UHCCP Medicaid |
$318.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$438.80
|
|
|
LAPAROSCOPY REPAIR OF COLOTOMY
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44238
|
| Hospital Charge Code |
76101834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,527.03 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,150.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,527.03
|
| Rate for Payer: Multiplan PHCS |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,505.00
|
| Rate for Payer: UHCCP Medicaid |
$752.50
|
|
|
LAPAROSCOPY REPAIR OF COLOTOMY
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44238
|
| Hospital Charge Code |
76101834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.50 |
| Max. Negotiated Rate |
$2,064.00 |
| Rate for Payer: Aetna Commercial |
$1,655.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,677.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cigna Commercial |
$1,784.50
|
| Rate for Payer: First Health Commercial |
$2,042.50
|
| Rate for Payer: Humana Commercial |
$1,827.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,763.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,586.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,892.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,612.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$666.50
|
| Rate for Payer: PHCS Commercial |
$2,064.00
|
| Rate for Payer: United Healthcare All Payer |
$1,892.00
|
|
|
LAPAROSCOPY REPAIR OF COLOTOMY
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44238
|
| Hospital Charge Code |
76101834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.50 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,655.50
|
| Rate for Payer: Anthem Medicaid |
$739.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,677.00
|
| 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 |
$1,075.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cigna Commercial |
$1,784.50
|
| Rate for Payer: First Health Commercial |
$2,042.50
|
| Rate for Payer: Humana Commercial |
$1,827.50
|
| Rate for Payer: Humana KY Medicaid |
$739.38
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$746.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,763.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,586.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$754.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,892.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,612.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$666.50
|
| Rate for Payer: PHCS Commercial |
$2,064.00
|
| Rate for Payer: United Healthcare All Payer |
$1,892.00
|
|
|
LAPAROSCOPY REPAIR OF COLOTOMY
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44238
|
| Hospital Charge Code |
761P1834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,527.03 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,150.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,527.03
|
| Rate for Payer: Multiplan PHCS |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,505.00
|
| Rate for Payer: UHCCP Medicaid |
$752.50
|
|
|
LAPAROSCOPY REPAIR OF VENOUS
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76101584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
LAPAROSCOPY REPAIR OF VENOUS
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76101584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
|
|
LAPAROSCOPY REPAIR OF VENOUS
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76101584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
LAPAROSCOPY REPAIR OF VENOUS(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761P1584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
|
|
LAPAROSCOPY SALPINGOSTOMY
|
Facility
|
OP
|
$2,010.00
|
|
|
Service Code
|
HCPCS 58673
|
| Hospital Charge Code |
76102253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.30 |
| Max. Negotiated Rate |
$12,462.13 |
| Rate for Payer: Aetna Commercial |
$1,547.70
|
| Rate for Payer: Anthem Medicaid |
$691.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,901.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,567.80
|
| 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 |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,668.30
|
| Rate for Payer: First Health Commercial |
$1,909.50
|
| Rate for Payer: Humana Commercial |
$1,708.50
|
| Rate for Payer: Humana KY Medicaid |
$691.24
|
| Rate for Payer: Humana Medicare Advantage |
$8,901.52
|
| Rate for Payer: Kentucky WC Medicaid |
$698.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,648.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,483.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,681.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$705.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,768.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,507.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$623.10
|
| Rate for Payer: PHCS Commercial |
$1,929.60
|
| Rate for Payer: United Healthcare All Payer |
$1,768.80
|
|
|
LAPAROSCOPY SALPINGOSTOMY
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 58673
|
| Hospital Charge Code |
76102253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$583.55 |
| Max. Negotiated Rate |
$2,010.00 |
| Rate for Payer: Aetna Commercial |
$1,234.26
|
| Rate for Payer: Anthem Medicaid |
$583.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,010.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,213.46
|
| Rate for Payer: Healthspan PPO |
$1,195.08
|
| Rate for Payer: Humana Medicaid |
$583.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,043.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.22
|
| Rate for Payer: Molina Healthcare Passport |
$583.55
|
| Rate for Payer: Multiplan PHCS |
$1,206.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,407.00
|
| Rate for Payer: UHCCP Medicaid |
$703.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$589.39
|
|
|
LAPAROSCOPY SALPINGOSTOMY
|
Facility
|
IP
|
$2,010.00
|
|
|
Service Code
|
HCPCS 58673
|
| Hospital Charge Code |
76102253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.30 |
| Max. Negotiated Rate |
$1,929.60 |
| Rate for Payer: Aetna Commercial |
$1,547.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,668.30
|
| Rate for Payer: First Health Commercial |
$1,909.50
|
| Rate for Payer: Humana Commercial |
$1,708.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,648.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,483.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$603.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,768.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,507.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$623.10
|
| Rate for Payer: PHCS Commercial |
$1,929.60
|
| Rate for Payer: United Healthcare All Payer |
$1,768.80
|
|
