|
LAPAROSCOPY ADRENALECTOMY(P
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS 60650
|
| Hospital Charge Code |
761P2282
|
|
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
|
|
|
LAPAROSCOPY CHOLECYSTECTOMY
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 47562
|
| Hospital Charge Code |
76101964
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$522.64 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,060.06
|
| Rate for Payer: Ambetter Exchange |
$631.60
|
| Rate for Payer: Anthem Medicaid |
$522.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$631.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$631.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$757.92
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$979.33
|
| Rate for Payer: Healthspan PPO |
$893.97
|
| Rate for Payer: Humana Medicaid |
$522.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$946.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$631.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$533.09
|
| Rate for Payer: Molina Healthcare Passport |
$522.64
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$821.08
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$527.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$631.60
|
|
|
LAPAROSCOPY CHOLECYSTECTOMY(P
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 47562
|
| Hospital Charge Code |
761P1964
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$522.64 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,060.06
|
| Rate for Payer: Ambetter Exchange |
$631.60
|
| Rate for Payer: Anthem Medicaid |
$522.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$631.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$631.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$757.92
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$979.33
|
| Rate for Payer: Healthspan PPO |
$893.97
|
| Rate for Payer: Humana Medicaid |
$522.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$946.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$631.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$533.09
|
| Rate for Payer: Molina Healthcare Passport |
$522.64
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$821.08
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$527.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$631.60
|
|
|
LAPAROSCOPY DX
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
76101987
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.24 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| 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 |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
LAPAROSCOPY DX
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
76101987
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
LAPAROSCOPY DX
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
76101987
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.39 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$476.60
|
| Rate for Payer: Ambetter Exchange |
$315.21
|
| Rate for Payer: Anthem Medicaid |
$258.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$315.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$378.25
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$450.05
|
| Rate for Payer: Healthspan PPO |
$401.92
|
| Rate for Payer: Humana Medicaid |
$258.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$315.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$263.56
|
| Rate for Payer: Molina Healthcare Passport |
$258.39
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.77
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$260.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$315.21
|
|
|
LAPAROSCOPY DX(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
761P1987
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.39 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$476.60
|
| Rate for Payer: Ambetter Exchange |
$315.21
|
| Rate for Payer: Anthem Medicaid |
$258.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$315.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$378.25
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$450.05
|
| Rate for Payer: Healthspan PPO |
$401.92
|
| Rate for Payer: Humana Medicaid |
$258.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$315.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$263.56
|
| Rate for Payer: Molina Healthcare Passport |
$258.39
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.77
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$260.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$315.21
|
|
|
LAPAROSCOPY ENTEROLYSIS
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
76101824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
LAPAROSCOPY ENTEROLYSIS
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
76101824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,335.26 |
| Rate for Payer: Aetna Commercial |
$1,335.26
|
| Rate for Payer: Ambetter Exchange |
$877.80
|
| Rate for Payer: Anthem Medicaid |
$635.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$877.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$877.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,053.36
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,247.71
|
| Rate for Payer: Healthspan PPO |
$1,126.05
|
| Rate for Payer: Humana Medicaid |
$635.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,175.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$877.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$877.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$647.94
|
| Rate for Payer: Molina Healthcare Passport |
$635.24
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,141.14
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$641.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$877.80
|
|
|
LAPAROSCOPY ENTEROLYSIS
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
76101824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.88 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| 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 |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Humana KY Medicaid |
$429.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$434.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
LAPAROSCOPY ENTEROLYSIS(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
761P1824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,335.26 |
| Rate for Payer: Aetna Commercial |
$1,335.26
|
| Rate for Payer: Ambetter Exchange |
$877.80
|
| Rate for Payer: Anthem Medicaid |
$635.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$877.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$877.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,053.36
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,247.71
|
| Rate for Payer: Healthspan PPO |
$1,126.05
|
| Rate for Payer: Humana Medicaid |
$635.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,175.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$877.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$877.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$647.94
|
| Rate for Payer: Molina Healthcare Passport |
$635.24
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,141.14
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$641.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$877.80
|
|
|
LAPAROSCOPY EXCIS TUMOR STOMAC
|
Facility
|
IP
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
76102802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,001.40 |
| Max. Negotiated Rate |
$3,204.48 |
| Rate for Payer: Aetna Commercial |
$2,570.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.64
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$2,770.54
|
| Rate for Payer: First Health Commercial |
$3,171.10
|
| Rate for Payer: Humana Commercial |
$2,837.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,737.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,904.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,303.22
|
| Rate for Payer: PHCS Commercial |
$3,204.48
|
| Rate for Payer: United Healthcare All Payer |
$2,937.44
|
|
|
LAPAROSCOPY EXCIS TUMOR STOMAC
|
Facility
|
OP
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
76102802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,147.94 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$2,570.26
|
| Rate for Payer: Anthem Medicaid |
$1,147.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.64
|
| 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 |
$1,669.00
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$2,770.54
|
| Rate for Payer: First Health Commercial |
$3,171.10
|
| Rate for Payer: Humana Commercial |
$2,837.30
|
| Rate for Payer: Humana KY Medicaid |
$1,147.94
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,159.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,737.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,170.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,904.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,303.22
|
| Rate for Payer: PHCS Commercial |
$3,204.48
|
| Rate for Payer: United Healthcare All Payer |
$2,937.44
|
|
|
LAPAROSCOPY EXCIS TUMOR STOMAC
|
Professional
|
Both
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
76102802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,336.60 |
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,002.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,336.60
|
| Rate for Payer: UHCCP Medicaid |
$1,168.30
|
|
|
LAPAROSCOPY GASTROSTOMY
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 43653
|
| Hospital Charge Code |
76101788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
LAPAROSCOPY GASTROSTOMY
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 43653
|
| Hospital Charge Code |
76101788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.37 |
| Max. Negotiated Rate |
$794.92 |
| Rate for Payer: Aetna Commercial |
$794.92
|
| Rate for Payer: Ambetter Exchange |
$551.45
|
| Rate for Payer: Anthem Medicaid |
$384.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$551.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$551.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.74
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$735.64
|
| Rate for Payer: Healthspan PPO |
$670.37
|
| Rate for Payer: Humana Medicaid |
$384.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$716.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$551.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.06
|
| Rate for Payer: Molina Healthcare Passport |
$384.37
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$716.88
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$388.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$551.45
|
|
|
LAPAROSCOPY GASTROSTOMY
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 43653
|
| Hospital Charge Code |
76101788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
LAPAROSCOPY GASTROSTOMY(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 43653
|
| Hospital Charge Code |
761P1788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.37 |
| Max. Negotiated Rate |
$794.92 |
| Rate for Payer: Aetna Commercial |
$794.92
|
| Rate for Payer: Ambetter Exchange |
$551.45
|
| Rate for Payer: Anthem Medicaid |
$384.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$551.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$551.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.74
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$735.64
|
| Rate for Payer: Healthspan PPO |
$670.37
|
| Rate for Payer: Humana Medicaid |
$384.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$716.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$551.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.06
|
| Rate for Payer: Molina Healthcare Passport |
$384.37
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$716.88
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$388.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$551.45
|
|
|
LAPAROSCOPY LYMPH NODE BIOP
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
76101602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$842.56 |
| Rate for Payer: Aetna Commercial |
$842.56
|
| Rate for Payer: Ambetter Exchange |
$489.64
|
| Rate for Payer: Anthem Medicaid |
$434.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$489.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$489.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$587.57
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$776.49
|
| Rate for Payer: Healthspan PPO |
$673.70
|
| Rate for Payer: Humana Medicaid |
$434.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$692.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$489.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$443.15
|
| Rate for Payer: Molina Healthcare Passport |
$434.46
|
| Rate for Payer: Multiplan PHCS |
$546.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$636.53
|
| Rate for Payer: UHCCP Medicaid |
$318.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$438.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$489.64
|
|
|
LAPAROSCOPY LYMPH NODE BIOP
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
76101602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.95 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem Medicaid |
$312.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| 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 |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Humana KY Medicaid |
$312.95
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$316.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
LAPAROSCOPY LYMPH NODE BIOP
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
76101602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
LAPAROSCOPY LYMPH NODE BIOP(P
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
761P1602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$842.56 |
| Rate for Payer: Aetna Commercial |
$842.56
|
| Rate for Payer: Ambetter Exchange |
$489.64
|
| Rate for Payer: Anthem Medicaid |
$434.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$489.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$489.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$587.57
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$776.49
|
| Rate for Payer: Healthspan PPO |
$673.70
|
| Rate for Payer: Humana Medicaid |
$434.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$692.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$489.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$443.15
|
| Rate for Payer: Molina Healthcare Passport |
$434.46
|
| Rate for Payer: Multiplan PHCS |
$546.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$636.53
|
| Rate for Payer: UHCCP Medicaid |
$318.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$438.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$489.64
|
|
|
LAPAROSCOPY REPAIR OF COLOTOMY
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44238
|
| Hospital Charge Code |
76101834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$645.00 |
| Max. Negotiated Rate |
$2,064.00 |
| Rate for Payer: Aetna Commercial |
$1,655.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,677.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cigna Commercial |
$1,784.50
|
| Rate for Payer: First Health Commercial |
$2,042.50
|
| Rate for Payer: Humana Commercial |
$1,827.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,763.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,586.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,892.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,612.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,870.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,483.50
|
| Rate for Payer: PHCS Commercial |
$2,064.00
|
| Rate for Payer: United Healthcare All Payer |
$1,892.00
|
|
|
LAPAROSCOPY REPAIR OF COLOTOMY
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44238
|
| Hospital Charge Code |
76101834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,527.03 |
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| 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 |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,505.00
|
| Rate for Payer: UHCCP Medicaid |
$752.50
|
|
|
LAPAROSCOPY REPAIR OF COLOTOMY
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44238
|
| Hospital Charge Code |
761P1834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,527.03 |
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| 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 |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,505.00
|
| Rate for Payer: UHCCP Medicaid |
$752.50
|
|
