|
LAPAROSCOPE PROC LYMPHATIC
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 38589
|
| Hospital Charge Code |
76101603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| 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: 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 |
$330.00
|
| 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(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 38589
|
| Hospital Charge Code |
761P1603
|
|
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
|
|
|
LAPAROSCOPE PROC STOM
|
Professional
|
Both
|
$937.50
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
76101789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$656.25 |
| Rate for Payer: Cash Price |
$468.75
|
| Rate for Payer: Cash Price |
$468.75
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$562.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$656.25
|
| Rate for Payer: UHCCP Medicaid |
$328.12
|
|
|
LAPAROSCOPIC 4 FUNC HANDSET
|
Facility
|
OP
|
$2,142.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$642.60 |
| Max. Negotiated Rate |
$2,056.32 |
| Rate for Payer: Aetna Commercial |
$1,649.34
|
| Rate for Payer: Anthem Medicaid |
$736.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,670.76
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna Commercial |
$1,777.86
|
| Rate for Payer: First Health Commercial |
$2,034.90
|
| Rate for Payer: Humana Commercial |
$1,820.70
|
| Rate for Payer: Humana KY Medicaid |
$736.63
|
| Rate for Payer: Kentucky WC Medicaid |
$744.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,756.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,580.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$642.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$751.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,884.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,606.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,863.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,477.98
|
| Rate for Payer: PHCS Commercial |
$2,056.32
|
| Rate for Payer: United Healthcare All Payer |
$1,884.96
|
|
|
LAPAROSCOPIC 4 FUNC HANDSET
|
Facility
|
IP
|
$2,142.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$642.60 |
| Max. Negotiated Rate |
$2,056.32 |
| Rate for Payer: Aetna Commercial |
$1,649.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,670.76
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna Commercial |
$1,777.86
|
| Rate for Payer: First Health Commercial |
$2,034.90
|
| Rate for Payer: Humana Commercial |
$1,820.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,756.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,580.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$642.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,884.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,606.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,863.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,477.98
|
| Rate for Payer: PHCS Commercial |
$2,056.32
|
| Rate for Payer: United Healthcare All Payer |
$1,884.96
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
76101872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
76101872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.19 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$849.46
|
| Rate for Payer: Ambetter Exchange |
$575.28
|
| Rate for Payer: Anthem Medicaid |
$395.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$575.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$575.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$690.34
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$787.77
|
| Rate for Payer: Healthspan PPO |
$716.36
|
| Rate for Payer: Humana Medicaid |
$395.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$757.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$575.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$403.09
|
| Rate for Payer: Molina Healthcare Passport |
$395.19
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$747.86
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$399.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$575.28
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
76101872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$653.41 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| 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 |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
LAPAROSCOPIC APPENDECTOMY(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
761P1872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.19 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$849.46
|
| Rate for Payer: Ambetter Exchange |
$575.28
|
| Rate for Payer: Anthem Medicaid |
$395.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$575.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$575.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$690.34
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$787.77
|
| Rate for Payer: Healthspan PPO |
$716.36
|
| Rate for Payer: Humana Medicaid |
$395.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$757.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$575.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$403.09
|
| Rate for Payer: Molina Healthcare Passport |
$395.19
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$747.86
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$399.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$575.28
|
|
|
LAPAROSCOPIC BLDDER INJ REPAIR
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
LAPAROSCOPIC BLDDER INJ REPAIR
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.58 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| 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 |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
LAPAROSCOPIC BLDDER INJ REPAIR
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,540.00 |
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Facility
|
OP
|
$5,022.14
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
76101973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$4,821.25 |
| Rate for Payer: Aetna Commercial |
$3,867.05
|
| Rate for Payer: Anthem Medicaid |
$1,727.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,917.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$2,511.07
|
| Rate for Payer: Cash Price |
$2,511.07
|
| Rate for Payer: Cigna Commercial |
$4,168.38
|
| Rate for Payer: First Health Commercial |
$4,771.03
|
| Rate for Payer: Humana Commercial |
$4,268.82
|
| Rate for Payer: Humana KY Medicaid |
$1,727.11
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,744.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,118.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,706.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,761.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,419.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,766.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,017.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,369.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,465.28
|
| Rate for Payer: PHCS Commercial |
$4,821.25
|
| Rate for Payer: United Healthcare All Payer |
$4,419.48
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Facility
|
IP
|
$5,022.14
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
76101973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,506.64 |
| Max. Negotiated Rate |
$4,821.25 |
| Rate for Payer: Aetna Commercial |
$3,867.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,917.27
|
| Rate for Payer: Cash Price |
$2,511.07
|
| Rate for Payer: Cigna Commercial |
$4,168.38
|
| Rate for Payer: First Health Commercial |
$4,771.03
|
| Rate for Payer: Humana Commercial |
$4,268.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,118.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,706.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,419.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,766.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,017.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,369.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,465.28
|
| Rate for Payer: PHCS Commercial |
$4,821.25
|
| Rate for Payer: United Healthcare All Payer |
$4,419.48
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Facility
|
IP
|
$3,772.14
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
761T1973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,131.64 |
| Max. Negotiated Rate |
$3,621.25 |
| Rate for Payer: Aetna Commercial |
$2,904.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,942.27
|
| Rate for Payer: Cash Price |
$1,886.07
|
| Rate for Payer: Cigna Commercial |
$3,130.88
|
| Rate for Payer: First Health Commercial |
$3,583.53
|
| Rate for Payer: Humana Commercial |
$3,206.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,093.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,783.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,131.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,319.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,829.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,017.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,281.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,602.78
|
| Rate for Payer: PHCS Commercial |
$3,621.25
|
| Rate for Payer: United Healthcare All Payer |
$3,319.48
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Professional
|
Both
|
$5,022.14
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
76101973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,515.50 |
| Rate for Payer: Cash Price |
$2,511.07
|
| Rate for Payer: Cash Price |
$2,511.07
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$3,013.28
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,515.50
|
| Rate for Payer: UHCCP Medicaid |
$1,757.75
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Facility
|
OP
|
$3,772.14
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
761T1973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$3,621.25 |
| Rate for Payer: Aetna Commercial |
$2,904.55
|
| Rate for Payer: Anthem Medicaid |
$1,297.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,942.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,886.07
|
| Rate for Payer: Cash Price |
$1,886.07
|
| Rate for Payer: Cigna Commercial |
$3,130.88
|
| Rate for Payer: First Health Commercial |
$3,583.53
|
| Rate for Payer: Humana Commercial |
$3,206.32
|
| Rate for Payer: Humana KY Medicaid |
$1,297.24
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,310.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,093.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,783.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,323.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,319.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,829.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,017.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,281.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,602.78
|
| Rate for Payer: PHCS Commercial |
$3,621.25
|
| Rate for Payer: United Healthcare All Payer |
$3,319.48
|
|
|
LAPAROSCOPIC DIS PANCREATECTMY
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 48999
|
| Hospital Charge Code |
761P1973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
|
|
LAPAROSCOPIC LIVER BIOPSY
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 47379
|
| Hospital Charge Code |
76102959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
|
|
LAPAROSCOPIC LIVER BIOPSY
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 47379
|
| Hospital Charge Code |
76102959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
LAPAROSCOPIC LIVER BIOPSY
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 47379
|
| Hospital Charge Code |
76102959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| 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 |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
LAPAROSCOPIC LYSIS ADHESIONS
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58660
|
| Hospital Charge Code |
76102248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.38 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$1,024.91
|
| Rate for Payer: Ambetter Exchange |
$652.23
|
| Rate for Payer: Anthem Medicaid |
$497.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$652.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$652.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$782.68
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$997.11
|
| Rate for Payer: Healthspan PPO |
$992.37
|
| Rate for Payer: Humana Medicaid |
$497.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$875.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$652.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$507.33
|
| Rate for Payer: Molina Healthcare Passport |
$497.38
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$847.90
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$502.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$652.23
|
|
|
LAPAROSCOPIC LYSIS ADHESIONS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58660
|
| Hospital Charge Code |
76102248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
LAPAROSCOPIC LYSIS ADHESIONS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58660
|
| Hospital Charge Code |
76102248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.58 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| 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 |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
LAPAROSCOPIC LYSIS ADHESIONS(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58660
|
| Hospital Charge Code |
761P2248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.38 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$1,024.91
|
| Rate for Payer: Ambetter Exchange |
$652.23
|
| Rate for Payer: Anthem Medicaid |
$497.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$652.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$652.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$782.68
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$997.11
|
| Rate for Payer: Healthspan PPO |
$992.37
|
| Rate for Payer: Humana Medicaid |
$497.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$875.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$652.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$507.33
|
| Rate for Payer: Molina Healthcare Passport |
$497.38
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$847.90
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$502.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$652.23
|
|
