|
LAP W/BIOPSY(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
761P1988
|
|
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/BSO
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
76102249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$503.77 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$985.37
|
| Rate for Payer: Anthem Medicaid |
$503.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$967.27
|
| Rate for Payer: Healthspan PPO |
$954.09
|
| Rate for Payer: Humana Medicaid |
$503.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$838.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$513.85
|
| Rate for Payer: Molina Healthcare Passport |
$503.77
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$508.81
|
|
|
LAP W/BSO
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
76102249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
LAP W/BSO
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
76102249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| 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 |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
LAP W/BSO(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
761P2249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$503.77 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$985.37
|
| Rate for Payer: Anthem Medicaid |
$503.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$967.27
|
| Rate for Payer: Healthspan PPO |
$954.09
|
| Rate for Payer: Humana Medicaid |
$503.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$838.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$513.85
|
| Rate for Payer: Molina Healthcare Passport |
$503.77
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$508.81
|
|
|
LAP W/BTS
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 58671
|
| Hospital Charge Code |
76102252
|
|
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/BTS
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 58671
|
| Hospital Charge Code |
76102252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$552.09
|
| Rate for Payer: Anthem Medicaid |
$287.90
|
| 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 |
$539.30
|
| Rate for Payer: Healthspan PPO |
$534.56
|
| Rate for Payer: Humana Medicaid |
$287.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$473.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$293.66
|
| Rate for Payer: Molina Healthcare Passport |
$287.90
|
| 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 |
$290.78
|
|
|
LAP W/BTS
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 58671
|
| Hospital Charge Code |
76102252
|
|
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
|
|
|
LAP W/BTS(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 58671
|
| Hospital Charge Code |
761P2252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$552.09
|
| Rate for Payer: Anthem Medicaid |
$287.90
|
| 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 |
$539.30
|
| Rate for Payer: Healthspan PPO |
$534.56
|
| Rate for Payer: Humana Medicaid |
$287.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$473.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$293.66
|
| Rate for Payer: Molina Healthcare Passport |
$287.90
|
| 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 |
$290.78
|
|
|
LAP W/ECTOPIC PREGNANCY
|
Facility
|
OP
|
$9,118.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
72000009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,185.34 |
| Max. Negotiated Rate |
$8,753.28 |
| Rate for Payer: Aetna Commercial |
$7,020.86
|
| Rate for Payer: Anthem Medicaid |
$3,135.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,112.04
|
| 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 |
$4,559.00
|
| Rate for Payer: Cash Price |
$4,559.00
|
| Rate for Payer: Cigna Commercial |
$7,567.94
|
| Rate for Payer: First Health Commercial |
$8,662.10
|
| Rate for Payer: Humana Commercial |
$7,750.30
|
| Rate for Payer: Humana KY Medicaid |
$3,135.68
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,167.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,476.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,729.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,198.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,023.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,838.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,823.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.58
|
| Rate for Payer: PHCS Commercial |
$8,753.28
|
| Rate for Payer: United Healthcare All Payer |
$8,023.84
|
|
|
LAP W/ECTOPIC PREGNANCY
|
Professional
|
Both
|
$9,118.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
72000009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$333.06 |
| Max. Negotiated Rate |
$9,118.00 |
| Rate for Payer: Aetna Commercial |
$1,259.83
|
| Rate for Payer: Anthem Medicaid |
$333.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,118.00
|
| Rate for Payer: Cash Price |
$4,559.00
|
| Rate for Payer: Cash Price |
$4,559.00
|
| Rate for Payer: Cigna Commercial |
$1,154.38
|
| Rate for Payer: Healthspan PPO |
$914.40
|
| Rate for Payer: Humana Medicaid |
$333.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,021.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.72
|
| Rate for Payer: Molina Healthcare Passport |
$333.06
|
| Rate for Payer: Multiplan PHCS |
$5,470.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,382.60
|
| Rate for Payer: UHCCP Medicaid |
$3,191.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.39
|
|
|
LAP W/ECTOPIC PREGNANCY
|
Facility
|
IP
|
$9,118.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
72000009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,185.34 |
| Max. Negotiated Rate |
$8,753.28 |
| Rate for Payer: Aetna Commercial |
$7,020.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,112.04
|
| Rate for Payer: Cash Price |
$4,559.00
|
| Rate for Payer: Cigna Commercial |
$7,567.94
|
| Rate for Payer: First Health Commercial |
$8,662.10
|
| Rate for Payer: Humana Commercial |
$7,750.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,476.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,729.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,735.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,023.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,838.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,823.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.58
|
| Rate for Payer: PHCS Commercial |
$8,753.28
|
| Rate for Payer: United Healthcare All Payer |
$8,023.84
|
|
|
LAP W/ECTOPIC PREGNANCY(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
720P0009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$333.06 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$1,259.83
|
| Rate for Payer: Anthem Medicaid |
$333.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,154.38
|
| Rate for Payer: Healthspan PPO |
$914.40
|
| Rate for Payer: Humana Medicaid |
$333.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,021.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.72
|
| Rate for Payer: Molina Healthcare Passport |
$333.06
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.39
|
|
|
LAP W/ECTOPIC PREGNANCY(T
|
Facility
|
IP
|
$7,218.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
720T0009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$938.34 |
| Max. Negotiated Rate |
$6,929.28 |
| Rate for Payer: Aetna Commercial |
$5,557.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,630.04
|
| Rate for Payer: Cash Price |
$3,609.00
|
| Rate for Payer: Cigna Commercial |
$5,990.94
|
| Rate for Payer: First Health Commercial |
$6,857.10
|
| Rate for Payer: Humana Commercial |
$6,135.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,918.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,326.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,351.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,413.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,237.58
|
| Rate for Payer: PHCS Commercial |
$6,929.28
|
| Rate for Payer: United Healthcare All Payer |
$6,351.84
|
|
|
LAP W/ECTOPIC PREGNANCY(T
|
Facility
|
OP
|
$7,218.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
720T0009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$938.34 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$5,557.86
|
| Rate for Payer: Anthem Medicaid |
$2,482.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,630.04
|
| 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 |
$3,609.00
|
| Rate for Payer: Cash Price |
$3,609.00
|
| Rate for Payer: Cigna Commercial |
$5,990.94
|
| Rate for Payer: First Health Commercial |
$6,857.10
|
| Rate for Payer: Humana Commercial |
$6,135.30
|
| Rate for Payer: Humana KY Medicaid |
$2,482.27
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,507.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,918.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,326.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,351.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,413.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,237.58
|
| Rate for Payer: PHCS Commercial |
$6,929.28
|
| Rate for Payer: United Healthcare All Payer |
$6,351.84
|
|
|
LAP W/OMENTOPEXY ADD-ON
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 49326
|
| Hospital Charge Code |
76101992
|
|
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 Medicaid |
$151.32
|
| 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: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| 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: Molina Healthcare Medicaid |
$154.35
|
| 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 W/OMENTOPEXY ADD-ON
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 49326
|
| Hospital Charge Code |
76101992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.28 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$284.23
|
| Rate for Payer: Anthem Medicaid |
$135.28
|
| 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 |
$261.63
|
| Rate for Payer: Healthspan PPO |
$239.69
|
| Rate for Payer: Humana Medicaid |
$135.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$245.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.99
|
| Rate for Payer: Molina Healthcare Passport |
$135.28
|
| 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 |
$136.63
|
|
|
LAP W/OMENTOPEXY ADD-ON
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 49326
|
| Hospital Charge Code |
76101992
|
|
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 W/OMENTOPEXY ADD-ON(P
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 49326
|
| Hospital Charge Code |
761P1992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.28 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$284.23
|
| Rate for Payer: Anthem Medicaid |
$135.28
|
| 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 |
$261.63
|
| Rate for Payer: Healthspan PPO |
$239.69
|
| Rate for Payer: Humana Medicaid |
$135.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$245.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.99
|
| Rate for Payer: Molina Healthcare Passport |
$135.28
|
| 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 |
$136.63
|
|
|
LAP W/ S/O
|
Professional
|
Both
|
$12,709.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
72000010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$458.93 |
| Max. Negotiated Rate |
$12,709.00 |
| Rate for Payer: Aetna Commercial |
$1,231.70
|
| Rate for Payer: Anthem Medicaid |
$458.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$12,709.00
|
| Rate for Payer: Cash Price |
$6,354.50
|
| Rate for Payer: Cash Price |
$6,354.50
|
| Rate for Payer: Cigna Commercial |
$1,139.52
|
| Rate for Payer: Healthspan PPO |
$893.99
|
| Rate for Payer: Humana Medicaid |
$458.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$997.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.11
|
| Rate for Payer: Molina Healthcare Passport |
$458.93
|
| Rate for Payer: Multiplan PHCS |
$7,625.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,896.30
|
| Rate for Payer: UHCCP Medicaid |
$4,448.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.52
|
|
|
LAP W/ S/O
|
Facility
|
IP
|
$12,709.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
72000010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,652.17 |
| Max. Negotiated Rate |
$12,200.64 |
| Rate for Payer: Aetna Commercial |
$9,785.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,913.02
|
| Rate for Payer: Cash Price |
$6,354.50
|
| Rate for Payer: Cigna Commercial |
$10,548.47
|
| Rate for Payer: First Health Commercial |
$12,073.55
|
| Rate for Payer: Humana Commercial |
$10,802.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,421.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,379.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,812.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,183.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,531.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,541.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,652.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,939.79
|
| Rate for Payer: PHCS Commercial |
$12,200.64
|
| Rate for Payer: United Healthcare All Payer |
$11,183.92
|
|
|
LAP W/ S/O
|
Facility
|
OP
|
$12,709.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
72000010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,652.17 |
| Max. Negotiated Rate |
$12,200.64 |
| Rate for Payer: Aetna Commercial |
$9,785.93
|
| Rate for Payer: Anthem Medicaid |
$4,370.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,913.02
|
| 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 |
$6,354.50
|
| Rate for Payer: Cash Price |
$6,354.50
|
| Rate for Payer: Cigna Commercial |
$10,548.47
|
| Rate for Payer: First Health Commercial |
$12,073.55
|
| Rate for Payer: Humana Commercial |
$10,802.65
|
| Rate for Payer: Humana KY Medicaid |
$4,370.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,415.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,421.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,379.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,458.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,183.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,531.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,541.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,652.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,939.79
|
| Rate for Payer: PHCS Commercial |
$12,200.64
|
| Rate for Payer: United Healthcare All Payer |
$11,183.92
|
|
|
LAP W/ S/O(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
720P0010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$458.93 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,231.70
|
| Rate for Payer: Anthem Medicaid |
$458.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,139.52
|
| Rate for Payer: Healthspan PPO |
$893.99
|
| Rate for Payer: Humana Medicaid |
$458.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$997.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.11
|
| Rate for Payer: Molina Healthcare Passport |
$458.93
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.52
|
|
|
LAP W/ S/O(T
|
Facility
|
OP
|
$10,409.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
720T0010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,353.17 |
| Max. Negotiated Rate |
$9,992.64 |
| Rate for Payer: Aetna Commercial |
$8,014.93
|
| Rate for Payer: Anthem Medicaid |
$3,579.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,119.02
|
| 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 |
$5,204.50
|
| Rate for Payer: Cash Price |
$5,204.50
|
| Rate for Payer: Cigna Commercial |
$8,639.47
|
| Rate for Payer: First Health Commercial |
$9,888.55
|
| Rate for Payer: Humana Commercial |
$8,847.65
|
| Rate for Payer: Humana KY Medicaid |
$3,579.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,616.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,535.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,681.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,651.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,159.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,806.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,081.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,353.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,226.79
|
| Rate for Payer: PHCS Commercial |
$9,992.64
|
| Rate for Payer: United Healthcare All Payer |
$9,159.92
|
|
|
LAP W/ S/O(T
|
Facility
|
IP
|
$10,409.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
720T0010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,353.17 |
| Max. Negotiated Rate |
$9,992.64 |
| Rate for Payer: Aetna Commercial |
$8,014.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,119.02
|
| Rate for Payer: Cash Price |
$5,204.50
|
| Rate for Payer: Cigna Commercial |
$8,639.47
|
| Rate for Payer: First Health Commercial |
$9,888.55
|
| Rate for Payer: Humana Commercial |
$8,847.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,535.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,681.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,122.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,159.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,806.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,081.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,353.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,226.79
|
| Rate for Payer: PHCS Commercial |
$9,992.64
|
| Rate for Payer: United Healthcare All Payer |
$9,159.92
|
|
