|
LAP COLECTOMY PART W/ANAST(P
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 44207
|
| Hospital Charge Code |
761P1831
|
|
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
|
|
|
LAP COLOSTOMY
|
Facility
|
IP
|
$3,020.00
|
|
|
Service Code
|
HCPCS 44188
|
| Hospital Charge Code |
76101826
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$2,899.20 |
| Rate for Payer: Aetna Commercial |
$2,325.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,355.60
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$2,506.60
|
| Rate for Payer: First Health Commercial |
$2,869.00
|
| Rate for Payer: Humana Commercial |
$2,567.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,476.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,228.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$906.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,657.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,265.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$392.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$936.20
|
| Rate for Payer: PHCS Commercial |
$2,899.20
|
| Rate for Payer: United Healthcare All Payer |
$2,657.60
|
|
|
LAP COLOSTOMY
|
Professional
|
Both
|
$3,020.00
|
|
|
Service Code
|
HCPCS 44188
|
| Hospital Charge Code |
76101826
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.58 |
| Max. Negotiated Rate |
$3,020.00 |
| Rate for Payer: Aetna Commercial |
$1,746.88
|
| Rate for Payer: Anthem Medicaid |
$806.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,020.00
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$1,632.93
|
| Rate for Payer: Healthspan PPO |
$1,473.17
|
| Rate for Payer: Humana Medicaid |
$806.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,551.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$822.71
|
| Rate for Payer: Molina Healthcare Passport |
$806.58
|
| Rate for Payer: Multiplan PHCS |
$1,812.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,114.00
|
| Rate for Payer: UHCCP Medicaid |
$1,057.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$814.65
|
|
|
LAP COLOSTOMY
|
Facility
|
OP
|
$3,020.00
|
|
|
Service Code
|
HCPCS 44188
|
| Hospital Charge Code |
76101826
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$2,899.20 |
| Rate for Payer: Aetna Commercial |
$2,325.40
|
| Rate for Payer: Anthem Medicaid |
$1,038.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,355.60
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$2,506.60
|
| Rate for Payer: First Health Commercial |
$2,869.00
|
| Rate for Payer: Humana Commercial |
$2,567.00
|
| Rate for Payer: Humana KY Medicaid |
$1,038.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,049.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,476.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,228.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$906.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,059.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,657.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,265.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$392.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$936.20
|
| Rate for Payer: PHCS Commercial |
$2,899.20
|
| Rate for Payer: United Healthcare All Payer |
$2,657.60
|
|
|
LAP COLOSTOMY(P
|
Professional
|
Both
|
$3,020.00
|
|
|
Service Code
|
HCPCS 44188
|
| Hospital Charge Code |
761P1826
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.58 |
| Max. Negotiated Rate |
$3,020.00 |
| Rate for Payer: Aetna Commercial |
$1,746.88
|
| Rate for Payer: Anthem Medicaid |
$806.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,020.00
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$1,632.93
|
| Rate for Payer: Healthspan PPO |
$1,473.17
|
| Rate for Payer: Humana Medicaid |
$806.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,551.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$822.71
|
| Rate for Payer: Molina Healthcare Passport |
$806.58
|
| Rate for Payer: Multiplan PHCS |
$1,812.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,114.00
|
| Rate for Payer: UHCCP Medicaid |
$1,057.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$814.65
|
|
|
LAP CURVED SPATULA ELECTRODE
|
Facility
|
IP
|
$554.74
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$532.55 |
| Rate for Payer: Aetna Commercial |
$427.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.70
|
| Rate for Payer: Cash Price |
$277.37
|
| Rate for Payer: Cigna Commercial |
$460.43
|
| Rate for Payer: First Health Commercial |
$527.00
|
| Rate for Payer: Humana Commercial |
$471.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.17
|
| Rate for Payer: Ohio Health Group HMO |
$416.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.97
|
| Rate for Payer: PHCS Commercial |
$532.55
|
| Rate for Payer: United Healthcare All Payer |
$488.17
|
|
|
LAP CURVED SPATULA ELECTRODE
|
Facility
|
OP
|
$554.74
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$532.55 |
| Rate for Payer: Aetna Commercial |
$427.15
|
| Rate for Payer: Anthem Medicaid |
$190.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.70
|
| Rate for Payer: Cash Price |
$277.37
|
| Rate for Payer: Cigna Commercial |
$460.43
|
| Rate for Payer: First Health Commercial |
$527.00
|
| Rate for Payer: Humana Commercial |
$471.53
|
| Rate for Payer: Humana KY Medicaid |
$190.78
|
| Rate for Payer: Kentucky WC Medicaid |
$192.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.17
|
| Rate for Payer: Ohio Health Group HMO |
$416.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.97
|
| Rate for Payer: PHCS Commercial |
$532.55
|
| Rate for Payer: United Healthcare All Payer |
$488.17
|
|
|
LAPIDUS WEDGE 5*5MM
|
Facility
|
IP
|
$9,368.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.86 |
| Max. Negotiated Rate |
$8,993.44 |
| Rate for Payer: Aetna Commercial |
$7,213.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.17
|
| Rate for Payer: Cash Price |
$4,684.09
|
| Rate for Payer: Cigna Commercial |
$7,775.58
|
| Rate for Payer: First Health Commercial |
$8,899.76
|
| Rate for Payer: Humana Commercial |
$7,962.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,681.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,243.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,873.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,217.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,904.13
|
| Rate for Payer: PHCS Commercial |
$8,993.44
|
| Rate for Payer: United Healthcare All Payer |
$8,243.99
|
|
|
LAPIDUS WEDGE 5*5MM
|
Facility
|
OP
|
$9,368.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.86 |
| Max. Negotiated Rate |
$8,993.44 |
| Rate for Payer: Aetna Commercial |
$7,213.49
|
| Rate for Payer: Anthem Medicaid |
$3,221.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.17
|
| Rate for Payer: Cash Price |
$4,684.09
|
| Rate for Payer: Cigna Commercial |
$7,775.58
|
| Rate for Payer: First Health Commercial |
$8,899.76
|
| Rate for Payer: Humana Commercial |
$7,962.94
|
| Rate for Payer: Humana KY Medicaid |
$3,221.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,681.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,243.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,873.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,217.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,904.13
|
| Rate for Payer: PHCS Commercial |
$8,993.44
|
| Rate for Payer: United Healthcare All Payer |
$8,243.99
|
|
|
LAPIDUS WEDGE 8*8MM
|
Facility
|
IP
|
$9,368.17
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.86 |
| Max. Negotiated Rate |
$8,993.44 |
| Rate for Payer: Aetna Commercial |
$7,213.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.17
|
| Rate for Payer: Cash Price |
$4,684.09
|
| Rate for Payer: Cigna Commercial |
$7,775.58
|
| Rate for Payer: First Health Commercial |
$8,899.76
|
| Rate for Payer: Humana Commercial |
$7,962.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,681.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,243.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,873.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,217.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,904.13
|
| Rate for Payer: PHCS Commercial |
$8,993.44
|
| Rate for Payer: United Healthcare All Payer |
$8,243.99
|
|
|
LAPIDUS WEDGE 8*8MM
|
Facility
|
OP
|
$9,368.17
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.86 |
| Max. Negotiated Rate |
$8,993.44 |
| Rate for Payer: Aetna Commercial |
$7,213.49
|
| Rate for Payer: Anthem Medicaid |
$3,221.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.17
|
| Rate for Payer: Cash Price |
$4,684.09
|
| Rate for Payer: Cigna Commercial |
$7,775.58
|
| Rate for Payer: First Health Commercial |
$8,899.76
|
| Rate for Payer: Humana Commercial |
$7,962.94
|
| Rate for Payer: Humana KY Medicaid |
$3,221.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,681.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,243.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,873.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,217.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,904.13
|
| Rate for Payer: PHCS Commercial |
$8,993.44
|
| Rate for Payer: United Healthcare All Payer |
$8,243.99
|
|
|
LAP ILEO/JEJUNO-STOMY
|
Professional
|
Both
|
$2,688.00
|
|
|
Service Code
|
HCPCS 44187
|
| Hospital Charge Code |
76102926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$734.68 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$1,576.47
|
| Rate for Payer: Anthem Medicaid |
$734.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,688.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cigna Commercial |
$1,482.90
|
| Rate for Payer: Healthspan PPO |
$1,329.47
|
| Rate for Payer: Humana Medicaid |
$734.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,396.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$749.37
|
| Rate for Payer: Molina Healthcare Passport |
$734.68
|
| Rate for Payer: Multiplan PHCS |
$1,612.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,881.60
|
| Rate for Payer: UHCCP Medicaid |
$940.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$742.03
|
|
|
LAP ILEO/JEJUNO-STOMY
|
Facility
|
OP
|
$2,688.00
|
|
|
Service Code
|
HCPCS 44187
|
| Hospital Charge Code |
76102926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.44 |
| Max. Negotiated Rate |
$2,580.48 |
| Rate for Payer: Aetna Commercial |
$2,069.76
|
| Rate for Payer: Anthem Medicaid |
$924.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,096.64
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cigna Commercial |
$2,231.04
|
| Rate for Payer: First Health Commercial |
$2,553.60
|
| Rate for Payer: Humana Commercial |
$2,284.80
|
| Rate for Payer: Humana KY Medicaid |
$924.40
|
| Rate for Payer: Kentucky WC Medicaid |
$933.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,204.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,983.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$806.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$942.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,365.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,016.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$537.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$833.28
|
| Rate for Payer: PHCS Commercial |
$2,580.48
|
| Rate for Payer: United Healthcare All Payer |
$2,365.44
|
|
|
LAP ILEO/JEJUNO-STOMY
|
Facility
|
IP
|
$2,688.00
|
|
|
Service Code
|
HCPCS 44187
|
| Hospital Charge Code |
76102926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.44 |
| Max. Negotiated Rate |
$2,580.48 |
| Rate for Payer: Aetna Commercial |
$2,069.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,096.64
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cigna Commercial |
$2,231.04
|
| Rate for Payer: First Health Commercial |
$2,553.60
|
| Rate for Payer: Humana Commercial |
$2,284.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,204.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,983.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$806.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,365.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,016.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$537.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$833.28
|
| Rate for Payer: PHCS Commercial |
$2,580.48
|
| Rate for Payer: United Healthcare All Payer |
$2,365.44
|
|
|
LAP INIT INGUIN HERN REPR
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
76102032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.13 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna Commercial |
$610.25
|
| Rate for Payer: Anthem Medicaid |
$302.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,040.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$565.57
|
| Rate for Payer: Healthspan PPO |
$514.63
|
| Rate for Payer: Humana Medicaid |
$302.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$536.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.17
|
| Rate for Payer: Molina Healthcare Passport |
$302.13
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.00
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.15
|
|
|
LAP INIT INGUIN HERN REPR(P
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
761P2032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.13 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna Commercial |
$610.25
|
| Rate for Payer: Anthem Medicaid |
$302.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,040.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$565.57
|
| Rate for Payer: Healthspan PPO |
$514.63
|
| Rate for Payer: Humana Medicaid |
$302.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$536.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.17
|
| Rate for Payer: Molina Healthcare Passport |
$302.13
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.00
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.15
|
|
|
LAP INSERTION PERM IP CATH
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 49324
|
| Hospital Charge Code |
76101991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
LAP INSERTION PERM IP CATH
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 49324
|
| Hospital Charge Code |
76101991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
LAP INSERTION PERM IP CATH
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 49324
|
| Hospital Charge Code |
76101991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$566.47
|
| Rate for Payer: Anthem Medicaid |
$270.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$528.76
|
| Rate for Payer: Healthspan PPO |
$477.71
|
| Rate for Payer: Humana Medicaid |
$270.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$503.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.49
|
| Rate for Payer: Molina Healthcare Passport |
$270.09
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.79
|
|
|
LAP INSERTION PERM IP CATH(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 49324
|
| Hospital Charge Code |
761P1991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$566.47
|
| Rate for Payer: Anthem Medicaid |
$270.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$528.76
|
| Rate for Payer: Healthspan PPO |
$477.71
|
| Rate for Payer: Humana Medicaid |
$270.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$503.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.49
|
| Rate for Payer: Molina Healthcare Passport |
$270.09
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.79
|
|
|
LAPIPLASTY SYSTEM 4
|
Facility
|
OP
|
$23,031.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.13 |
| Max. Negotiated Rate |
$22,110.48 |
| Rate for Payer: Aetna Commercial |
$17,734.45
|
| Rate for Payer: Anthem Medicaid |
$7,920.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,964.76
|
| Rate for Payer: Cash Price |
$11,515.88
|
| Rate for Payer: Cigna Commercial |
$19,116.35
|
| Rate for Payer: First Health Commercial |
$21,880.16
|
| Rate for Payer: Humana Commercial |
$19,576.99
|
| Rate for Payer: Humana KY Medicaid |
$7,920.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,001.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,886.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,997.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,909.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,079.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,267.94
|
| Rate for Payer: Ohio Health Group HMO |
$17,273.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,606.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,139.84
|
| Rate for Payer: PHCS Commercial |
$22,110.48
|
| Rate for Payer: United Healthcare All Payer |
$20,267.94
|
|
|
LAPIPLASTY SYSTEM 4
|
Facility
|
IP
|
$23,031.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.13 |
| Max. Negotiated Rate |
$22,110.48 |
| Rate for Payer: Aetna Commercial |
$17,734.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,964.76
|
| Rate for Payer: Cash Price |
$11,515.88
|
| Rate for Payer: Cigna Commercial |
$19,116.35
|
| Rate for Payer: First Health Commercial |
$21,880.16
|
| Rate for Payer: Humana Commercial |
$19,576.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,886.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,997.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,909.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,267.94
|
| Rate for Payer: Ohio Health Group HMO |
$17,273.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,606.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,139.84
|
| Rate for Payer: PHCS Commercial |
$22,110.48
|
| Rate for Payer: United Healthcare All Payer |
$20,267.94
|
|
|
LAP MOBILIZATION SPLENIC FLE(P
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 44213
|
| Hospital Charge Code |
761P1832
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.37 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$286.90
|
| Rate for Payer: Anthem Medicaid |
$146.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$440.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$273.79
|
| Rate for Payer: Healthspan PPO |
$241.95
|
| Rate for Payer: Humana Medicaid |
$146.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$244.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.30
|
| Rate for Payer: Molina Healthcare Passport |
$146.37
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$308.00
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.83
|
|
|
LAP MOBILIZATION SPLENIC FLEX
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 44213
|
| Hospital Charge Code |
76101832
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
LAP MOBILIZATION SPLENIC FLEX
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 44213
|
| Hospital Charge Code |
76101832
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.37 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$286.90
|
| Rate for Payer: Anthem Medicaid |
$146.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$440.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$273.79
|
| Rate for Payer: Healthspan PPO |
$241.95
|
| Rate for Payer: Humana Medicaid |
$146.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$244.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.30
|
| Rate for Payer: Molina Healthcare Passport |
$146.37
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$308.00
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.83
|
|
