|
LAPAROSCOPY REPAIR OF COLOTOMY
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44238
|
| Hospital Charge Code |
76101834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.38 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,655.50
|
| Rate for Payer: Anthem Medicaid |
$739.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,677.00
|
| 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 |
$1,075.00
|
| 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: Humana KY Medicaid |
$739.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$746.91
|
| 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 |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$754.22
|
| 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 VENOUS
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76101584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
|
|
LAPAROSCOPY REPAIR OF VENOUS
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76101584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| 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 |
$571.26
|
| 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 |
$685.51
|
| 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 REPAIR OF VENOUS
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76101584
|
|
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 REPAIR OF VENOUS(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761P1584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
|
|
LAPAROSCOPY SALPINGOSTOMY
|
Facility
|
IP
|
$2,010.00
|
|
|
Service Code
|
HCPCS 58673
|
| Hospital Charge Code |
76102253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$603.00 |
| Max. Negotiated Rate |
$1,929.60 |
| Rate for Payer: Aetna Commercial |
$1,547.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,668.30
|
| Rate for Payer: First Health Commercial |
$1,909.50
|
| Rate for Payer: Humana Commercial |
$1,708.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,648.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,483.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$603.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,768.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,507.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,748.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.90
|
| Rate for Payer: PHCS Commercial |
$1,929.60
|
| Rate for Payer: United Healthcare All Payer |
$1,768.80
|
|
|
LAPAROSCOPY SALPINGOSTOMY
|
Facility
|
OP
|
$2,010.00
|
|
|
Service Code
|
HCPCS 58673
|
| Hospital Charge Code |
76102253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$691.24 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$1,547.70
|
| Rate for Payer: Anthem Medicaid |
$691.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,567.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,467.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,986.68
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,668.30
|
| Rate for Payer: First Health Commercial |
$1,909.50
|
| Rate for Payer: Humana Commercial |
$1,708.50
|
| Rate for Payer: Humana KY Medicaid |
$691.24
|
| Rate for Payer: Humana Medicare Advantage |
$9,619.76
|
| Rate for Payer: Kentucky WC Medicaid |
$698.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,648.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,483.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,543.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$705.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,768.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,507.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,748.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.90
|
| Rate for Payer: PHCS Commercial |
$1,929.60
|
| Rate for Payer: United Healthcare All Payer |
$1,768.80
|
|
|
LAPAROSCOPY SALPINGOSTOMY
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 58673
|
| Hospital Charge Code |
76102253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$583.55 |
| Max. Negotiated Rate |
$1,234.26 |
| Rate for Payer: Aetna Commercial |
$1,234.26
|
| Rate for Payer: Ambetter Exchange |
$751.87
|
| Rate for Payer: Anthem Medicaid |
$583.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$751.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$751.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$902.24
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,213.46
|
| Rate for Payer: Healthspan PPO |
$1,195.08
|
| Rate for Payer: Humana Medicaid |
$583.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,043.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$751.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$751.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.22
|
| Rate for Payer: Molina Healthcare Passport |
$583.55
|
| Rate for Payer: Multiplan PHCS |
$1,206.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$977.43
|
| Rate for Payer: UHCCP Medicaid |
$703.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$589.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$751.87
|
|
|
LAPAROSCOPY SALPINGOSTOMY(P
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 58673
|
| Hospital Charge Code |
761P2253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$583.55 |
| Max. Negotiated Rate |
$1,234.26 |
| Rate for Payer: Aetna Commercial |
$1,234.26
|
| Rate for Payer: Ambetter Exchange |
$751.87
|
| Rate for Payer: Anthem Medicaid |
$583.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$751.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$751.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$902.24
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,213.46
|
| Rate for Payer: Healthspan PPO |
$1,195.08
|
| Rate for Payer: Humana Medicaid |
$583.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,043.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$751.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$751.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.22
|
| Rate for Payer: Molina Healthcare Passport |
$583.55
|
| Rate for Payer: Multiplan PHCS |
$1,206.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$977.43
|
| Rate for Payer: UHCCP Medicaid |
$703.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$589.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$751.87
|
|
|
LAPAROSCOPY SURG
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 51990
|
| Hospital Charge Code |
76102079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
LAPAROSCOPY SURG
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 51990
|
| Hospital Charge Code |
76102079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$534.61 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$1,207.53
|
| Rate for Payer: Ambetter Exchange |
$704.24
|
| Rate for Payer: Anthem Medicaid |
$534.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$704.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$704.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$845.09
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,119.49
|
| Rate for Payer: Healthspan PPO |
$965.53
|
| Rate for Payer: Humana Medicaid |
$534.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,025.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$704.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$704.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.30
|
| Rate for Payer: Molina Healthcare Passport |
$534.61
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$915.51
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$539.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$704.24
|
|
|
LAPAROSCOPY SURG
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 51990
|
| Hospital Charge Code |
76102079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.14 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| 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 |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
LAPAROSCOPY SURG COLPOPEXY
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 57425
|
| Hospital Charge Code |
76102978
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$1,483.21 |
| Rate for Payer: Aetna Commercial |
$1,483.21
|
| Rate for Payer: Ambetter Exchange |
$921.37
|
| Rate for Payer: Anthem Medicaid |
$669.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$921.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$921.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,105.64
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,404.64
|
| Rate for Payer: Healthspan PPO |
$1,436.12
|
| Rate for Payer: Humana Medicaid |
$669.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,263.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$921.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$921.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$682.69
|
| Rate for Payer: Molina Healthcare Passport |
$669.30
|
| Rate for Payer: Multiplan PHCS |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,197.78
|
| Rate for Payer: UHCCP Medicaid |
$831.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$675.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$921.37
|
|
|
LAPAROSCOPY, SURGICAL; ABLATION OF RENAL MASS LESION(S), INCLUDING INTRAOPERATIVE ULTRASOUND GUIDANCE AND MONITORING, WHEN PERFORMED
|
Facility
|
OP
|
$13,467.66
|
|
|
Service Code
|
CPT 50542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,619.76 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,467.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,986.68
|
| Rate for Payer: Humana Medicare Advantage |
$9,619.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,543.71
|
|
|
LAPAROSCOPY, SURGICAL, APPENDECTOMY
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 44970
|
|
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, SURGICAL; CHOLECYSTECTOMY
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 47562
|
|
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, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 47563
|
|
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, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT
|
Facility
|
OP
|
$13,467.66
|
|
|
Service Code
|
CPT 47564
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,619.76 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,467.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,986.68
|
| Rate for Payer: Humana Medicare Advantage |
$9,619.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,543.71
|
|
|
LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 44180
|
|
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 - SURGICAL - ESO
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 43280
|
| Hospital Charge Code |
76101764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.43 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem Medicaid |
$567.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,467.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,986.68
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Humana KY Medicaid |
$567.43
|
| Rate for Payer: Humana Medicare Advantage |
$9,619.76
|
| Rate for Payer: Kentucky WC Medicaid |
$573.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,543.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$578.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
LAPAROSCOPY - SURGICAL - ESO
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 43280
|
| Hospital Charge Code |
76101764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,578.22 |
| Rate for Payer: Aetna Commercial |
$1,578.22
|
| Rate for Payer: Ambetter Exchange |
$1,027.27
|
| Rate for Payer: Anthem Medicaid |
$820.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,027.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,027.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,232.72
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,478.24
|
| Rate for Payer: Healthspan PPO |
$1,330.94
|
| Rate for Payer: Humana Medicaid |
$820.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,386.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,027.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$836.70
|
| Rate for Payer: Molina Healthcare Passport |
$820.29
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,335.45
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$828.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,027.27
|
|
|
LAPAROSCOPY - SURGICAL - ESO
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 43280
|
| Hospital Charge Code |
76101764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.00 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
LAPAROSCOPY - SURGICAL - ESO(P
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 43280
|
| Hospital Charge Code |
761P1764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,578.22 |
| Rate for Payer: Aetna Commercial |
$1,578.22
|
| Rate for Payer: Ambetter Exchange |
$1,027.27
|
| Rate for Payer: Anthem Medicaid |
$820.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,027.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,027.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,232.72
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,478.24
|
| Rate for Payer: Healthspan PPO |
$1,330.94
|
| Rate for Payer: Humana Medicaid |
$820.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,386.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,027.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$836.70
|
| Rate for Payer: Molina Healthcare Passport |
$820.29
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,335.45
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$828.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,027.27
|
|
|
LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES)
|
Facility
|
OP
|
$13,467.66
|
|
|
Service Code
|
CPT 43280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,619.76 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,467.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,986.68
|
| Rate for Payer: Humana Medicare Advantage |
$9,619.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,543.71
|
|
|
LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 49650
|
|
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
|
|
