|
LAPAROSCOPIC MYOMECTOMY
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58545
|
| Hospital Charge Code |
76103006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$657.30 |
| Max. Negotiated Rate |
$1,360.63 |
| Rate for Payer: Aetna Commercial |
$1,360.63
|
| Rate for Payer: Ambetter Exchange |
$855.27
|
| Rate for Payer: Anthem Medicaid |
$657.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$855.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$855.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,026.32
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,334.29
|
| Rate for Payer: Healthspan PPO |
$1,317.44
|
| Rate for Payer: Humana Medicaid |
$657.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,165.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$855.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$670.45
|
| Rate for Payer: Molina Healthcare Passport |
$657.30
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,111.85
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$663.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$855.27
|
|
|
LAPAROSCOPIC PLICATION DIPHRGM
|
Facility
|
OP
|
$3,095.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
76101624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$928.50 |
| Max. Negotiated Rate |
$2,971.20 |
| Rate for Payer: Aetna Commercial |
$2,383.15
|
| Rate for Payer: Anthem Medicaid |
$1,064.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,414.10
|
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Cigna Commercial |
$2,568.85
|
| Rate for Payer: First Health Commercial |
$2,940.25
|
| Rate for Payer: Humana Commercial |
$2,630.75
|
| Rate for Payer: Humana KY Medicaid |
$1,064.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,075.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,537.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,284.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,085.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,723.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,321.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,692.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.55
|
| Rate for Payer: PHCS Commercial |
$2,971.20
|
| Rate for Payer: United Healthcare All Payer |
$2,723.60
|
|
|
LAPAROSCOPIC PLICATION DIPHRGM
|
Facility
|
IP
|
$3,095.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
76101624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$928.50 |
| Max. Negotiated Rate |
$2,971.20 |
| Rate for Payer: Aetna Commercial |
$2,383.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,414.10
|
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Cigna Commercial |
$2,568.85
|
| Rate for Payer: First Health Commercial |
$2,940.25
|
| Rate for Payer: Humana Commercial |
$2,630.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,537.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,284.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,723.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,321.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,692.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.55
|
| Rate for Payer: PHCS Commercial |
$2,971.20
|
| Rate for Payer: United Healthcare All Payer |
$2,723.60
|
|
|
LAPAROSCOPIC PLICATION DIPHRGM
|
Professional
|
Both
|
$3,095.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
76101624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,166.50 |
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,857.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,166.50
|
| Rate for Payer: UHCCP Medicaid |
$1,083.25
|
|
|
LAPAROSCOPIC PLICATION DIPHRGM
|
Professional
|
Both
|
$3,095.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
761P1624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,166.50 |
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Cash Price |
$1,547.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,857.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,166.50
|
| Rate for Payer: UHCCP Medicaid |
$1,083.25
|
|
|
LAPAROSCOPIC REMOVAL OF IUD
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.44 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem Medicaid |
$426.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| 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 |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Humana KY Medicaid |
$426.44
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$430.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
LAPAROSCOPIC REMOVAL OF IUD
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$868.00 |
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$868.00
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
|
|
LAPAROSCOPIC REMOVAL OF IUD
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$1,190.40 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
LAPAROSCOPIC REV OF COLOSTOMY
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 44238
|
| Hospital Charge Code |
76102768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,527.03 |
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,527.03
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$854.00
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
|
|
LAPAROSCOPIC SALPINGECTOMY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58679
|
| Hospital Charge Code |
76102254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| 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 |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
LAPAROSCOPIC SALPINGECTOMY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58679
|
| Hospital Charge Code |
76102254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
LAPAROSCOPIC SALPINGECTOMY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58679
|
| Hospital Charge Code |
76102254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
|
|
LAPAROSCOPIC SALPINGECTOMY(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58679
|
| Hospital Charge Code |
761P2254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
|
|
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 59150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 59151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
LAPAROSCOP LYSIS OMENTAL ADHES
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102920
|
|
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
|
|
|
LAPAROSCOP LYSIS OMENTAL ADHES
|
Facility
|
IP
|
$2,695.00
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
76102911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.50 |
| Max. Negotiated Rate |
$2,587.20 |
| Rate for Payer: Aetna Commercial |
$2,075.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,102.10
|
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: Cigna Commercial |
$2,236.85
|
| Rate for Payer: First Health Commercial |
$2,560.25
|
| Rate for Payer: Humana Commercial |
$2,290.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,209.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,988.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$808.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,371.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,021.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,344.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,859.55
|
| Rate for Payer: PHCS Commercial |
$2,587.20
|
| Rate for Payer: United Healthcare All Payer |
$2,371.60
|
|
|
LAPAROSCOP LYSIS OMENTAL ADHES
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102920
|
|
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
|
|
|
LAPAROSCOP LYSIS OMENTAL ADHES
|
Facility
|
OP
|
$2,695.00
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
76102911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$926.81 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$2,075.15
|
| Rate for Payer: Anthem Medicaid |
$926.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,102.10
|
| 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 |
$1,347.50
|
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: Cigna Commercial |
$2,236.85
|
| Rate for Payer: First Health Commercial |
$2,560.25
|
| Rate for Payer: Humana Commercial |
$2,290.75
|
| Rate for Payer: Humana KY Medicaid |
$926.81
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$936.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,209.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,988.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$945.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,371.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,021.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,344.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,859.55
|
| Rate for Payer: PHCS Commercial |
$2,587.20
|
| Rate for Payer: United Healthcare All Payer |
$2,371.60
|
|
|
LAPAROSCOP LYSIS OMENTAL ADHES
|
Professional
|
Both
|
$2,695.00
|
|
|
Service Code
|
HCPCS 51999
|
| Hospital Charge Code |
76102911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,886.50 |
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,617.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,886.50
|
| Rate for Payer: UHCCP Medicaid |
$943.25
|
|
|
LAPAROSCOP LYSIS OMENTAL ADHES
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 49329
|
| Hospital Charge Code |
76102920
|
|
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
|
|
|
LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 49320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
LAPAROSCOPY ADRENALECTOMY
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 60650
|
| Hospital Charge Code |
76102282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$1,353.60 |
| Rate for Payer: Aetna Commercial |
$1,085.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,099.80
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$1,170.30
|
| Rate for Payer: First Health Commercial |
$1,339.50
|
| Rate for Payer: Humana Commercial |
$1,198.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,156.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,040.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$423.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,240.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,057.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,226.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$972.90
|
| Rate for Payer: PHCS Commercial |
$1,353.60
|
| Rate for Payer: United Healthcare All Payer |
$1,240.80
|
|
|
LAPAROSCOPY ADRENALECTOMY
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 60650
|
| Hospital Charge Code |
76102282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$1,353.60 |
| Rate for Payer: Aetna Commercial |
$1,085.70
|
| Rate for Payer: Anthem Medicaid |
$484.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,099.80
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$1,170.30
|
| Rate for Payer: First Health Commercial |
$1,339.50
|
| Rate for Payer: Humana Commercial |
$1,198.50
|
| Rate for Payer: Humana KY Medicaid |
$484.90
|
| Rate for Payer: Kentucky WC Medicaid |
$489.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,156.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,040.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$423.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$494.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,240.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,057.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,226.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$972.90
|
| Rate for Payer: PHCS Commercial |
$1,353.60
|
| Rate for Payer: United Healthcare All Payer |
$1,240.80
|
|
|
LAPAROSCOPY ADRENALECTOMY
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS 60650
|
| Hospital Charge Code |
76102282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.50 |
| Max. Negotiated Rate |
$1,803.56 |
| Rate for Payer: Aetna Commercial |
$1,803.56
|
| Rate for Payer: Ambetter Exchange |
$1,136.98
|
| Rate for Payer: Anthem Medicaid |
$739.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,136.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,136.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,364.38
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$1,668.31
|
| Rate for Payer: Healthspan PPO |
$1,520.98
|
| Rate for Payer: Humana Medicaid |
$739.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,543.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,136.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$754.52
|
| Rate for Payer: Molina Healthcare Passport |
$739.73
|
| Rate for Payer: Multiplan PHCS |
$846.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,478.07
|
| Rate for Payer: UHCCP Medicaid |
$493.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$747.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,136.98
|
|
