|
LAMISIL (TERBINAFINE HCL)250MG
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 51991052601
|
| Hospital Charge Code |
25000837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
LAMISIL (TERBINAFINE HCL)250MG
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 51991052601
|
| Hospital Charge Code |
25000837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
LANGSTON CATH 6FR
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
LANGSTON CATH 6FR
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
LANOXIN (DIGOXIN) O .25MG/5ML
|
Facility
|
IP
|
$34.36
|
|
|
Service Code
|
NDC 17856005701
|
| Hospital Charge Code |
25000839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$32.99 |
| Rate for Payer: Aetna Commercial |
$26.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.80
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: First Health Commercial |
$32.64
|
| Rate for Payer: Humana Commercial |
$29.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.24
|
| Rate for Payer: Ohio Health Group HMO |
$25.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.71
|
| Rate for Payer: PHCS Commercial |
$32.99
|
| Rate for Payer: United Healthcare All Payer |
$30.24
|
|
|
LANOXIN (DIGOXIN) O .25MG/5ML
|
Facility
|
OP
|
$34.36
|
|
|
Service Code
|
NDC 17856005701
|
| Hospital Charge Code |
25000839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$32.99 |
| Rate for Payer: Aetna Commercial |
$26.46
|
| Rate for Payer: Anthem Medicaid |
$11.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.80
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: First Health Commercial |
$32.64
|
| Rate for Payer: Humana Commercial |
$29.21
|
| Rate for Payer: Humana KY Medicaid |
$11.82
|
| Rate for Payer: Kentucky WC Medicaid |
$11.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.24
|
| Rate for Payer: Ohio Health Group HMO |
$25.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.71
|
| Rate for Payer: PHCS Commercial |
$32.99
|
| Rate for Payer: United Healthcare All Payer |
$30.24
|
|
|
LANTERN MICROCATHETER 135 ST.
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem Medicaid |
$1,526.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Humana KY Medicaid |
$1,526.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,541.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,556.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
LANTERN MICROCATHETER 135 ST.
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
LANTUS (PER UNIT) SUB-Q
|
Facility
|
IP
|
$64.95
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna Commercial |
$50.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.66
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cigna Commercial |
$53.91
|
| Rate for Payer: First Health Commercial |
$61.70
|
| Rate for Payer: Humana Commercial |
$55.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.16
|
| Rate for Payer: Ohio Health Group HMO |
$48.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.82
|
| Rate for Payer: PHCS Commercial |
$62.35
|
| Rate for Payer: United Healthcare All Payer |
$57.16
|
|
|
LANTUS (PER UNIT) SUB-Q
|
Facility
|
OP
|
$64.95
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna Commercial |
$50.01
|
| Rate for Payer: Anthem Medicaid |
$22.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.66
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cigna Commercial |
$53.91
|
| Rate for Payer: First Health Commercial |
$61.70
|
| Rate for Payer: Humana Commercial |
$55.21
|
| Rate for Payer: Humana KY Medicaid |
$22.34
|
| Rate for Payer: Kentucky WC Medicaid |
$22.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.16
|
| Rate for Payer: Ohio Health Group HMO |
$48.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.82
|
| Rate for Payer: PHCS Commercial |
$62.35
|
| Rate for Payer: United Healthcare All Payer |
$57.16
|
|
|
LAPARO ABLATE RENAL CYST
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 50541
|
| Hospital Charge Code |
76102801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.15
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
|
LAPARO ABLATE RENAL CYST
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 50541
|
| Hospital Charge Code |
76102801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.55 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem Medicaid |
$321.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,467.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,986.68
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Humana KY Medicaid |
$321.55
|
| Rate for Payer: Humana Medicare Advantage |
$9,619.76
|
| Rate for Payer: Kentucky WC Medicaid |
$324.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,543.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$328.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.15
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
|
LAPARO ABLATE RENAL CYST
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 50541
|
| Hospital Charge Code |
76102801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,505.11 |
| Rate for Payer: Aetna Commercial |
$1,505.11
|
| Rate for Payer: Ambetter Exchange |
$866.30
|
| Rate for Payer: Anthem Medicaid |
$654.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$866.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$866.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,039.56
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$1,344.19
|
| Rate for Payer: Healthspan PPO |
$1,203.47
|
| Rate for Payer: Humana Medicaid |
$654.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,256.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$866.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$866.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$667.56
|
| Rate for Payer: Molina Healthcare Passport |
$654.47
|
| Rate for Payer: Multiplan PHCS |
$561.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,126.19
|
| Rate for Payer: UHCCP Medicaid |
$327.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$661.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$866.30
|
|
|
LAPARO ABLATE RENAL MASS
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 50542
|
| Hospital Charge Code |
76102914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.12 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem Medicaid |
$980.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,467.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,986.68
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Humana KY Medicaid |
$980.12
|
| Rate for Payer: Humana Medicare Advantage |
$9,619.76
|
| Rate for Payer: Kentucky WC Medicaid |
$990.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,543.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$999.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,479.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,966.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
|
LAPARO ABLATE RENAL MASS
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 50542
|
| Hospital Charge Code |
76102914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.28 |
| Max. Negotiated Rate |
$1,907.78 |
| Rate for Payer: Aetna Commercial |
$1,907.78
|
| Rate for Payer: Ambetter Exchange |
$1,099.58
|
| Rate for Payer: Anthem Medicaid |
$825.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,099.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,099.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,319.50
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$1,695.91
|
| Rate for Payer: Healthspan PPO |
$1,525.44
|
| Rate for Payer: Humana Medicaid |
$825.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,594.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,099.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$841.79
|
| Rate for Payer: Molina Healthcare Passport |
$825.28
|
| Rate for Payer: Multiplan PHCS |
$1,710.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,429.45
|
| Rate for Payer: UHCCP Medicaid |
$997.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$833.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,099.58
|
|
|
LAPARO ABLATE RENAL MASS
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 50542
|
| Hospital Charge Code |
76102914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$855.00 |
| Max. Negotiated Rate |
$2,736.00 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,479.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,966.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
|
LAPARO DRAIN LYMPHOCELE
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49323
|
| Hospital Charge Code |
76101990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| 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 |
$5,390.83
|
| 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 |
$6,469.00
|
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
LAPARO DRAIN LYMPHOCELE
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49323
|
| Hospital Charge Code |
76101990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
LAPARO DRAIN LYMPHOCELE
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49323
|
| Hospital Charge Code |
76101990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$924.46 |
| Rate for Payer: Aetna Commercial |
$924.46
|
| Rate for Payer: Ambetter Exchange |
$610.32
|
| Rate for Payer: Anthem Medicaid |
$444.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$610.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$732.38
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$856.20
|
| Rate for Payer: Healthspan PPO |
$779.61
|
| Rate for Payer: Humana Medicaid |
$444.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$610.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.69
|
| Rate for Payer: Molina Healthcare Passport |
$444.79
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$793.42
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$610.32
|
|
|
LAPARO DRAIN LYMPHOCELE(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49323
|
| Hospital Charge Code |
761P1990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$924.46 |
| Rate for Payer: Aetna Commercial |
$924.46
|
| Rate for Payer: Ambetter Exchange |
$610.32
|
| Rate for Payer: Anthem Medicaid |
$444.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$610.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$732.38
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$856.20
|
| Rate for Payer: Healthspan PPO |
$779.61
|
| Rate for Payer: Humana Medicaid |
$444.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$610.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.69
|
| Rate for Payer: Molina Healthcare Passport |
$444.79
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$793.42
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$610.32
|
|
|
LAPARO PROC ABDM/PER/OMENT
|
Facility
|
OP
|
$817.50
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76101993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.14 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$629.48
|
| Rate for Payer: Anthem Medicaid |
$281.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$637.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cigna Commercial |
$678.52
|
| Rate for Payer: First Health Commercial |
$776.62
|
| Rate for Payer: Humana Commercial |
$694.88
|
| Rate for Payer: Humana KY Medicaid |
$281.14
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$284.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$670.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$603.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$719.40
|
| Rate for Payer: Ohio Health Group HMO |
$613.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.08
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
LAPARO PROC ABDM/PER/OMENT
|
Facility
|
IP
|
$817.50
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76101993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.25 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Aetna Commercial |
$629.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$637.65
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cigna Commercial |
$678.52
|
| Rate for Payer: First Health Commercial |
$776.62
|
| Rate for Payer: Humana Commercial |
$694.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$670.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$603.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$719.40
|
| Rate for Payer: Ohio Health Group HMO |
$613.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.08
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
LAPARO PROC ABDM/PER/OMENT
|
Professional
|
Both
|
$817.50
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76101993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$572.25 |
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$490.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$572.25
|
| Rate for Payer: UHCCP Medicaid |
$286.12
|
|
|
LAPARO PROC ABDM/PER/OMENT(P
|
Professional
|
Both
|
$817.50
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
761P1993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$572.25 |
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$490.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$572.25
|
| Rate for Payer: UHCCP Medicaid |
$286.12
|
|
|
LAPARO PROC HERNIA REPAIR
|
Professional
|
Both
|
$2,650.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
76102040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,855.00 |
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,590.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,855.00
|
| Rate for Payer: UHCCP Medicaid |
$927.50
|
|
