|
LAPARO PROC HERNIA REPAIR
|
Facility
|
IP
|
$2,650.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
76102040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$795.00 |
| Max. Negotiated Rate |
$2,544.00 |
| Rate for Payer: Aetna Commercial |
$2,040.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,067.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cigna Commercial |
$2,199.50
|
| Rate for Payer: First Health Commercial |
$2,517.50
|
| Rate for Payer: Humana Commercial |
$2,252.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,173.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,955.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$795.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,332.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,828.50
|
| Rate for Payer: PHCS Commercial |
$2,544.00
|
| Rate for Payer: United Healthcare All Payer |
$2,332.00
|
|
|
LAPARO PROC HERNIA REPAIR
|
Facility
|
OP
|
$2,650.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
76102040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$911.34 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$2,040.50
|
| Rate for Payer: Anthem Medicaid |
$911.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,067.00
|
| 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 |
$1,325.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cigna Commercial |
$2,199.50
|
| Rate for Payer: First Health Commercial |
$2,517.50
|
| Rate for Payer: Humana Commercial |
$2,252.50
|
| Rate for Payer: Humana KY Medicaid |
$911.34
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$920.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,173.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,955.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$929.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,332.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,828.50
|
| Rate for Payer: PHCS Commercial |
$2,544.00
|
| Rate for Payer: United Healthcare All Payer |
$2,332.00
|
|
|
LAPARO PROC HERNIA REPAIR(P
|
Professional
|
Both
|
$2,650.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
761P2040
|
|
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
|
|
|
LAPARO RADICAL NEPHRECTOMY
|
Facility
|
IP
|
$2,925.00
|
|
|
Service Code
|
HCPCS 50545
|
| Hospital Charge Code |
76102052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$877.50 |
| Max. Negotiated Rate |
$2,808.00 |
| Rate for Payer: Aetna Commercial |
$2,252.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,281.50
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cigna Commercial |
$2,427.75
|
| Rate for Payer: First Health Commercial |
$2,778.75
|
| Rate for Payer: Humana Commercial |
$2,486.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,398.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,158.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$877.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,574.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,193.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,544.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,018.25
|
| Rate for Payer: PHCS Commercial |
$2,808.00
|
| Rate for Payer: United Healthcare All Payer |
$2,574.00
|
|
|
LAPARO RADICAL NEPHRECTOMY
|
Facility
|
OP
|
$2,925.00
|
|
|
Service Code
|
HCPCS 50545
|
| Hospital Charge Code |
76102052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$877.50 |
| Max. Negotiated Rate |
$2,808.00 |
| Rate for Payer: Aetna Commercial |
$2,252.25
|
| Rate for Payer: Anthem Medicaid |
$1,005.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,281.50
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cigna Commercial |
$2,427.75
|
| Rate for Payer: First Health Commercial |
$2,778.75
|
| Rate for Payer: Humana Commercial |
$2,486.25
|
| Rate for Payer: Humana KY Medicaid |
$1,005.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,016.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,398.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,158.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$877.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,026.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,574.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,193.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,544.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,018.25
|
| Rate for Payer: PHCS Commercial |
$2,808.00
|
| Rate for Payer: United Healthcare All Payer |
$2,574.00
|
|
|
LAPARO RADICAL NEPHRECTOMY
|
Professional
|
Both
|
$2,925.00
|
|
|
Service Code
|
HCPCS 50545
|
| Hospital Charge Code |
76102052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$978.83 |
| Max. Negotiated Rate |
$2,207.53 |
| Rate for Payer: Aetna Commercial |
$2,207.53
|
| Rate for Payer: Ambetter Exchange |
$1,258.58
|
| Rate for Payer: Anthem Medicaid |
$978.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,258.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,258.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,510.30
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cigna Commercial |
$1,972.57
|
| Rate for Payer: Healthspan PPO |
$1,765.12
|
| Rate for Payer: Humana Medicaid |
$978.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,837.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,258.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$998.41
|
| Rate for Payer: Molina Healthcare Passport |
$978.83
|
| Rate for Payer: Multiplan PHCS |
$1,755.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,636.15
|
| Rate for Payer: UHCCP Medicaid |
$1,023.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$988.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,258.58
|
|
|
LAPARO RADICAL NEPHRECTOMY(P
|
Professional
|
Both
|
$2,925.00
|
|
|
Service Code
|
HCPCS 50545
|
| Hospital Charge Code |
761P2052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$978.83 |
| Max. Negotiated Rate |
$2,207.53 |
| Rate for Payer: Aetna Commercial |
$2,207.53
|
| Rate for Payer: Ambetter Exchange |
$1,258.58
|
| Rate for Payer: Anthem Medicaid |
$978.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,258.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,258.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,510.30
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cigna Commercial |
$1,972.57
|
| Rate for Payer: Healthspan PPO |
$1,765.12
|
| Rate for Payer: Humana Medicaid |
$978.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,837.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,258.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$998.41
|
| Rate for Payer: Molina Healthcare Passport |
$978.83
|
| Rate for Payer: Multiplan PHCS |
$1,755.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,636.15
|
| Rate for Payer: UHCCP Medicaid |
$1,023.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$988.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,258.58
|
|
|
LAPAROSCOPE PROC APP
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 44979
|
| Hospital Charge Code |
76101873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
|
|
LAPAROSCOPE PROC APP
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 44979
|
| Hospital Charge Code |
76101873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.57 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem Medicaid |
$94.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| 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 |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Humana KY Medicaid |
$94.57
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$95.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.75
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
LAPAROSCOPE PROC APP
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 44979
|
| Hospital Charge Code |
76101873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.75
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
LAPAROSCOPE PROC APP(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 44979
|
| Hospital Charge Code |
761P1873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
|
|
LAPAROSCOPE PROC BLA
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
76102080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
LAPAROSCOPE PROC BLA
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
76102080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.80 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
LAPAROSCOPE PROC BLA
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
76102080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
LAPAROSCOPE PROC BLA(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
761P2080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
LAPAROSCOPE PROCEDURE LIVER
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47379
|
| Hospital Charge Code |
76101953
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,238.04 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| 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 |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LAPAROSCOPE PROCEDURE LIVER
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47379
|
| Hospital Charge Code |
76101953
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,080.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LAPAROSCOPE PROCEDURE LIVER
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47379
|
| Hospital Charge Code |
76101953
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,520.00
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
|
|
LAPAROSCOPE PROCEDURE LIVER(P
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47379
|
| Hospital Charge Code |
761P1953
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,520.00
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
|
|
LAPAROSCOPE PROC ESOPH
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 43289
|
| Hospital Charge Code |
76101768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.28 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem Medicaid |
$421.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| 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 |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Humana KY Medicaid |
$421.28
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$425.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$429.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$845.25
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
LAPAROSCOPE PROC ESOPH
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 43289
|
| Hospital Charge Code |
76101768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$857.50 |
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$735.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$857.50
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
|
|
LAPAROSCOPE PROC ESOPH
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 43289
|
| Hospital Charge Code |
76101768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$845.25
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
LAPAROSCOPE PROC ESOPH(P
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 43289
|
| Hospital Charge Code |
761P1768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$857.50 |
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$735.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$857.50
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
|
|
LAPAROSCOPE PROC LYMPHATIC
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 38589
|
| Hospital Charge Code |
76101603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| 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 |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
LAPAROSCOPE PROC LYMPHATIC
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 38589
|
| Hospital Charge Code |
76101603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
|
