|
LAPBAND ADJUSTMENT
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
51000148
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$51.58
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$52.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
LAPBAND ADJUSTMENT
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
51000148
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
LAP BIL TUBAL
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58670
|
| Hospital Charge Code |
76102251
|
|
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
|
|
|
LAP BIL TUBAL
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58670
|
| Hospital Charge Code |
76102251
|
|
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
|
|
|
LAP BIL TUBAL
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58670
|
| Hospital Charge Code |
76102251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.12 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$551.91
|
| Rate for Payer: Anthem Medicaid |
$280.12
|
| 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 |
$538.71
|
| Rate for Payer: Healthspan PPO |
$534.39
|
| Rate for Payer: Humana Medicaid |
$280.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$474.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.72
|
| Rate for Payer: Molina Healthcare Passport |
$280.12
|
| 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 |
$282.92
|
|
|
LAP BIL TUBAL(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58670
|
| Hospital Charge Code |
761P2251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.12 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$551.91
|
| Rate for Payer: Anthem Medicaid |
$280.12
|
| 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 |
$538.71
|
| Rate for Payer: Healthspan PPO |
$534.39
|
| Rate for Payer: Humana Medicaid |
$280.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$474.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.72
|
| Rate for Payer: Molina Healthcare Passport |
$280.12
|
| 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 |
$282.92
|
|
|
LAP CHOLECYSTECTOMY
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47564
|
| Hospital Charge Code |
76101966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.69 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$1,261.01
|
| Rate for Payer: Anthem Medicaid |
$667.69
|
| 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: Cigna Commercial |
$1,182.57
|
| Rate for Payer: Healthspan PPO |
$1,063.44
|
| Rate for Payer: Humana Medicaid |
$667.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,102.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$681.04
|
| Rate for Payer: Molina Healthcare Passport |
$667.69
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$674.37
|
|
|
LAP CHOLECYSTECTOMY
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47564
|
| Hospital Charge Code |
76101966
|
|
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
|
|
|
LAP CHOLECYSTECTOMY
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47564
|
| Hospital Charge Code |
76101966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$12,462.13 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,901.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| 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 |
$1,800.00
|
| 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 |
$8,901.52
|
| 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 |
$10,681.82
|
| 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
|
|
|
LAP CHOLECYSTECTOMY(P
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47564
|
| Hospital Charge Code |
761P1966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.69 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$1,261.01
|
| Rate for Payer: Anthem Medicaid |
$667.69
|
| 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: Cigna Commercial |
$1,182.57
|
| Rate for Payer: Healthspan PPO |
$1,063.44
|
| Rate for Payer: Humana Medicaid |
$667.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,102.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$681.04
|
| Rate for Payer: Molina Healthcare Passport |
$667.69
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$674.37
|
|
|
LAP CHOLECYSTECTOMY W/CHOLANGI
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
76101965
|
|
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
|
|
|
LAP CHOLECYSTECTOMY W/CHOLANGI
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
76101965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,088.48 |
| Rate for Payer: Aetna Commercial |
$1,088.48
|
| Rate for Payer: Anthem Medicaid |
$562.24
|
| 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 |
$1,017.30
|
| Rate for Payer: Healthspan PPO |
$917.93
|
| Rate for Payer: Humana Medicaid |
$562.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$959.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$573.48
|
| Rate for Payer: Molina Healthcare Passport |
$562.24
|
| 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 |
$567.86
|
|
|
LAP CHOLECYSTECTOMY W/CHOLANGI
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
76101965
|
|
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
|
|
|
LAP CHOLECYSTECTOMY W/CHOLANGI
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
761P1965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,088.48 |
| Rate for Payer: Aetna Commercial |
$1,088.48
|
| Rate for Payer: Anthem Medicaid |
$562.24
|
| 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 |
$1,017.30
|
| Rate for Payer: Healthspan PPO |
$917.93
|
| Rate for Payer: Humana Medicaid |
$562.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$959.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$573.48
|
| Rate for Payer: Molina Healthcare Passport |
$562.24
|
| 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 |
$567.86
|
|
|
LAP CLOSE ENTEROSTOMY
|
Professional
|
Both
|
$3,700.00
|
|
|
Service Code
|
HCPCS 44227
|
| Hospital Charge Code |
76101833
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,145.29 |
| Max. Negotiated Rate |
$3,700.00 |
| Rate for Payer: Aetna Commercial |
$2,433.39
|
| Rate for Payer: Anthem Medicaid |
$1,145.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,700.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$2,275.44
|
| Rate for Payer: Healthspan PPO |
$2,052.12
|
| Rate for Payer: Humana Medicaid |
$1,145.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,139.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,168.20
|
| Rate for Payer: Molina Healthcare Passport |
$1,145.29
|
| Rate for Payer: Multiplan PHCS |
$2,220.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,590.00
|
| Rate for Payer: UHCCP Medicaid |
$1,295.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,156.74
|
|
|
LAP CLOSE ENTEROSTOMY
|
Facility
|
IP
|
$3,700.00
|
|
|
Service Code
|
HCPCS 44227
|
| Hospital Charge Code |
76101833
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna Commercial |
$2,849.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,886.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$3,071.00
|
| Rate for Payer: First Health Commercial |
$3,515.00
|
| Rate for Payer: Humana Commercial |
$3,145.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,034.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,256.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,147.00
|
| Rate for Payer: PHCS Commercial |
$3,552.00
|
| Rate for Payer: United Healthcare All Payer |
$3,256.00
|
|
|
LAP CLOSE ENTEROSTOMY
|
Facility
|
OP
|
$3,700.00
|
|
|
Service Code
|
HCPCS 44227
|
| Hospital Charge Code |
76101833
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna Commercial |
$2,849.00
|
| Rate for Payer: Anthem Medicaid |
$1,272.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,886.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$3,071.00
|
| Rate for Payer: First Health Commercial |
$3,515.00
|
| Rate for Payer: Humana Commercial |
$3,145.00
|
| Rate for Payer: Humana KY Medicaid |
$1,272.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,034.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,110.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,256.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,147.00
|
| Rate for Payer: PHCS Commercial |
$3,552.00
|
| Rate for Payer: United Healthcare All Payer |
$3,256.00
|
|
|
LAP CLOSE ENTEROSTOMY(P
|
Professional
|
Both
|
$3,700.00
|
|
|
Service Code
|
HCPCS 44227
|
| Hospital Charge Code |
761P1833
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,145.29 |
| Max. Negotiated Rate |
$3,700.00 |
| Rate for Payer: Aetna Commercial |
$2,433.39
|
| Rate for Payer: Anthem Medicaid |
$1,145.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,700.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$2,275.44
|
| Rate for Payer: Healthspan PPO |
$2,052.12
|
| Rate for Payer: Humana Medicaid |
$1,145.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,139.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,168.20
|
| Rate for Payer: Molina Healthcare Passport |
$1,145.29
|
| Rate for Payer: Multiplan PHCS |
$2,220.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,590.00
|
| Rate for Payer: UHCCP Medicaid |
$1,295.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,156.74
|
|
|
LAP COLECTOMY PARTIAL
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 44205
|
| Hospital Charge Code |
76101829
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
LAP COLECTOMY PARTIAL
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 44205
|
| Hospital Charge Code |
76101829
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
LAP COLECTOMY PARTIAL
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 44205
|
| Hospital Charge Code |
76101829
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$918.82 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,962.89
|
| Rate for Payer: Anthem Medicaid |
$918.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,843.93
|
| Rate for Payer: Healthspan PPO |
$1,655.34
|
| Rate for Payer: Humana Medicaid |
$918.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,714.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$937.20
|
| Rate for Payer: Molina Healthcare Passport |
$918.82
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$928.01
|
|
|
LAP COLECTOMY PARTIAL(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 44205
|
| Hospital Charge Code |
761P1829
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$918.82 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,962.89
|
| Rate for Payer: Anthem Medicaid |
$918.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,843.93
|
| Rate for Payer: Healthspan PPO |
$1,655.34
|
| Rate for Payer: Humana Medicaid |
$918.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,714.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$937.20
|
| Rate for Payer: Molina Healthcare Passport |
$918.82
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$928.01
|
|
|
LAP COLECTOMY PART W/ANAST
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 44207
|
| Hospital Charge Code |
76101831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
LAP COLECTOMY PART W/ANAST
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 44207
|
| Hospital Charge Code |
76101831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
LAP COLECTOMY PART W/ANAST
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 44207
|
| Hospital Charge Code |
76101831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,224.87 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$2,678.25
|
| Rate for Payer: Anthem Medicaid |
$1,224.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$2,511.87
|
| Rate for Payer: Healthspan PPO |
$2,258.62
|
| Rate for Payer: Humana Medicaid |
$1,224.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,342.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,249.37
|
| Rate for Payer: Molina Healthcare Passport |
$1,224.87
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,800.00
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,237.12
|
|
