|
LAPS PX SPRMATIC CORD
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55559
|
| Hospital Charge Code |
76102898
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,000.00 |
| 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: Healthspan PPO |
$0.60
|
| 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
|
|
|
LAPS PX SPRMATIC CORD
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55559
|
| Hospital Charge Code |
76102898
|
|
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 SUPRCERV HYSTERECT > 250 G
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58543
|
| Hospital Charge Code |
761P2229
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$696.59 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,464.75
|
| Rate for Payer: Anthem Medicaid |
$696.59
|
| 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 |
$1,393.73
|
| Rate for Payer: Healthspan PPO |
$1,418.25
|
| Rate for Payer: Humana Medicaid |
$696.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,271.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$710.52
|
| Rate for Payer: Molina Healthcare Passport |
$696.59
|
| 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 |
$703.56
|
|
|
LAP SUPRCERV HYSTERECT > 250 G
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58543
|
| Hospital Charge Code |
76102229
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$696.59 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,464.75
|
| Rate for Payer: Anthem Medicaid |
$696.59
|
| 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 |
$1,393.73
|
| Rate for Payer: Healthspan PPO |
$1,418.25
|
| Rate for Payer: Humana Medicaid |
$696.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,271.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$710.52
|
| Rate for Payer: Molina Healthcare Passport |
$696.59
|
| 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 |
$703.56
|
|
|
LAP SUPRCERV HYSTERECT > 250 G
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58543
|
| Hospital Charge Code |
76102229
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| 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: 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 SUPRCERV HYSTERECT > 250 G
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58543
|
| Hospital Charge Code |
76102229
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$12,462.13 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,901.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| 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 |
$1,500.00
|
| 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: Humana Medicare Advantage |
$8,901.52
|
| 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 |
$10,681.82
|
| 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 SURG ENTRCTMY RESEC SM INT
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
76101827
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
LAP SURG ENTRCTMY RESEC SM INT
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
76101827
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
LAP SURG ENTRCTMY RESEC SM INT
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
76101827
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$2,013.97
|
| Rate for Payer: Anthem Medicaid |
$1,003.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,880.78
|
| Rate for Payer: Healthspan PPO |
$1,698.42
|
| Rate for Payer: Humana Medicaid |
$1,003.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,772.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,023.48
|
| Rate for Payer: Molina Healthcare Passport |
$1,003.41
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,013.44
|
|
|
LAP SURG ENTRCTMY RESEC SM INT
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
761P1827
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$2,013.97
|
| Rate for Payer: Anthem Medicaid |
$1,003.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,880.78
|
| Rate for Payer: Healthspan PPO |
$1,698.42
|
| Rate for Payer: Humana Medicaid |
$1,003.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,772.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,023.48
|
| Rate for Payer: Molina Healthcare Passport |
$1,003.41
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,013.44
|
|
|
LAP SURG GSTRC RSTRCT REMVL
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 43774
|
| Hospital Charge Code |
76101795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.40 |
| Max. Negotiated Rate |
$4,636.52 |
| Rate for Payer: Aetna Commercial |
$908.60
|
| Rate for Payer: Anthem Medicaid |
$405.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$920.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,636.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,470.93
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$979.40
|
| Rate for Payer: First Health Commercial |
$1,121.00
|
| Rate for Payer: Humana Commercial |
$1,003.00
|
| Rate for Payer: Humana KY Medicaid |
$405.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
| Rate for Payer: Kentucky WC Medicaid |
$409.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$967.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$870.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$413.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,038.40
|
| Rate for Payer: Ohio Health Group HMO |
$885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.80
|
| Rate for Payer: PHCS Commercial |
$1,132.80
|
| Rate for Payer: United Healthcare All Payer |
$1,038.40
|
|
|
LAP SURG GSTRC RSTRCT REMVL
|
Professional
|
Both
|
$1,180.00
|
|
|
Service Code
|
HCPCS 43774
|
| Hospital Charge Code |
76101795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$1,380.42 |
| Rate for Payer: Aetna Commercial |
$1,380.42
|
| Rate for Payer: Anthem Medicaid |
$660.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,180.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$1,292.35
|
| Rate for Payer: Healthspan PPO |
$1,164.13
|
| Rate for Payer: Humana Medicaid |
$660.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,224.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$673.82
|
| Rate for Payer: Molina Healthcare Passport |
$660.61
|
| Rate for Payer: Multiplan PHCS |
$708.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$826.00
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$667.22
|
|
|
LAP SURG GSTRC RSTRCT REMVL
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 43774
|
| Hospital Charge Code |
76101795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.40 |
| Max. Negotiated Rate |
$1,132.80 |
| Rate for Payer: Aetna Commercial |
$908.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$920.40
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$979.40
|
| Rate for Payer: First Health Commercial |
$1,121.00
|
| Rate for Payer: Humana Commercial |
$1,003.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$967.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$870.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,038.40
|
| Rate for Payer: Ohio Health Group HMO |
$885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.80
|
| Rate for Payer: PHCS Commercial |
$1,132.80
|
| Rate for Payer: United Healthcare All Payer |
$1,038.40
|
|
|
LAP SURG GSTRC RSTRCT REMVL(P
|
Professional
|
Both
|
$1,180.00
|
|
|
Service Code
|
HCPCS 43774
|
| Hospital Charge Code |
761P1795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$1,380.42 |
| Rate for Payer: Aetna Commercial |
$1,380.42
|
| Rate for Payer: Anthem Medicaid |
$660.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,180.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$1,292.35
|
| Rate for Payer: Healthspan PPO |
$1,164.13
|
| Rate for Payer: Humana Medicaid |
$660.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,224.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$673.82
|
| Rate for Payer: Molina Healthcare Passport |
$660.61
|
| Rate for Payer: Multiplan PHCS |
$708.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$826.00
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$667.22
|
|
|
LAP SURG JEJUNOSTOMY
|
Professional
|
Both
|
$1,705.00
|
|
|
Service Code
|
HCPCS 44186
|
| Hospital Charge Code |
76101825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$1,705.00 |
| Rate for Payer: Aetna Commercial |
$939.25
|
| Rate for Payer: Anthem Medicaid |
$445.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,705.00
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna Commercial |
$877.85
|
| Rate for Payer: Healthspan PPO |
$792.09
|
| Rate for Payer: Humana Medicaid |
$445.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$832.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.16
|
| Rate for Payer: Molina Healthcare Passport |
$445.25
|
| Rate for Payer: Multiplan PHCS |
$1,023.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,193.50
|
| Rate for Payer: UHCCP Medicaid |
$596.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.70
|
|
|
LAP SURG JEJUNOSTOMY
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
HCPCS 44186
|
| Hospital Charge Code |
76101825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.65 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,312.85
|
| Rate for Payer: Anthem Medicaid |
$586.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.90
|
| 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 |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna Commercial |
$1,415.15
|
| Rate for Payer: First Health Commercial |
$1,619.75
|
| Rate for Payer: Humana Commercial |
$1,449.25
|
| Rate for Payer: Humana KY Medicaid |
$586.35
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$592.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.55
|
| Rate for Payer: PHCS Commercial |
$1,636.80
|
| Rate for Payer: United Healthcare All Payer |
$1,500.40
|
|
|
LAP SURG JEJUNOSTOMY
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
HCPCS 44186
|
| Hospital Charge Code |
76101825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.65 |
| Max. Negotiated Rate |
$1,636.80 |
| Rate for Payer: Aetna Commercial |
$1,312.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.90
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna Commercial |
$1,415.15
|
| Rate for Payer: First Health Commercial |
$1,619.75
|
| Rate for Payer: Humana Commercial |
$1,449.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.55
|
| Rate for Payer: PHCS Commercial |
$1,636.80
|
| Rate for Payer: United Healthcare All Payer |
$1,500.40
|
|
|
LAP SURG JEJUNOSTOMY(P
|
Professional
|
Both
|
$1,705.00
|
|
|
Service Code
|
HCPCS 44186
|
| Hospital Charge Code |
761P1825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$1,705.00 |
| Rate for Payer: Aetna Commercial |
$939.25
|
| Rate for Payer: Anthem Medicaid |
$445.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,705.00
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna Commercial |
$877.85
|
| Rate for Payer: Healthspan PPO |
$792.09
|
| Rate for Payer: Humana Medicaid |
$445.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$832.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.16
|
| Rate for Payer: Molina Healthcare Passport |
$445.25
|
| Rate for Payer: Multiplan PHCS |
$1,023.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,193.50
|
| Rate for Payer: UHCCP Medicaid |
$596.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.70
|
|
|
LAP W/ASPIRATION
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 49322
|
| Hospital Charge Code |
76101989
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| 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 |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
LAP W/ASPIRATION
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 49322
|
| Hospital Charge Code |
76101989
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
LAP W/ASPIRATION
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 49322
|
| Hospital Charge Code |
76101989
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.25 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$544.47
|
| Rate for Payer: Anthem Medicaid |
$286.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$516.60
|
| Rate for Payer: Healthspan PPO |
$459.16
|
| Rate for Payer: Humana Medicaid |
$286.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$474.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$291.98
|
| Rate for Payer: Molina Healthcare Passport |
$286.25
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$289.11
|
|
|
LAP W/ASPIRATION(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 49322
|
| Hospital Charge Code |
761P1989
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.25 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$544.47
|
| Rate for Payer: Anthem Medicaid |
$286.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$516.60
|
| Rate for Payer: Healthspan PPO |
$459.16
|
| Rate for Payer: Humana Medicaid |
$286.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$474.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$291.98
|
| Rate for Payer: Molina Healthcare Passport |
$286.25
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$289.11
|
|
|
LAP W/BIOPSY
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
76101988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.28 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$502.29
|
| Rate for Payer: Anthem Medicaid |
$275.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$470.49
|
| Rate for Payer: Healthspan PPO |
$423.59
|
| Rate for Payer: Humana Medicaid |
$275.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$442.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$280.79
|
| Rate for Payer: Molina Healthcare Passport |
$275.28
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$278.03
|
|
|
LAP W/BIOPSY
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
76101988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
LAP W/BIOPSY
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
76101988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
