|
LAPAROSCOPY W/TKDWN FUNDOPLICA
|
Professional
|
Both
|
$2,305.00
|
|
|
Service Code
|
HCPCS 43289
|
| Hospital Charge Code |
76102758
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,613.50 |
| Rate for Payer: Cash Price |
$1,152.50
|
| Rate for Payer: Cash Price |
$1,152.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,383.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,613.50
|
| Rate for Payer: UHCCP Medicaid |
$806.75
|
|
|
LAPAROSCPIC REM IUD OFF UTERUS
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 58578
|
| Hospital Charge Code |
76103042
|
|
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
|
|
|
LAPAROSC REV GASTROJEJUNOSTOMY
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
76103033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: Anthem Medicaid |
$100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$100.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.00
|
| Rate for Payer: Molina Healthcare Passport |
$100.00
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.00
|
|
|
LAPAROSC UNROOFING SPLEN CYST
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 38129
|
| Hospital Charge Code |
76102930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$654.50 |
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$561.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$654.50
|
| Rate for Payer: UHCCP Medicaid |
$327.25
|
|
|
LAPAROSC UNROOFING SPLEN CYST
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 38129
|
| Hospital Charge Code |
76102930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.55 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem Medicaid |
$321.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| 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 |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Humana KY Medicaid |
$321.55
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$324.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$328.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.15
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
|
LAPAROSC UNROOFING SPLEN CYST
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 38129
|
| Hospital Charge Code |
76102930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.15
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
|
LAPARO-VAG HYST W/T/O COMPL
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58554
|
| Hospital Charge Code |
76102232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$1,976.53 |
| Rate for Payer: Aetna Commercial |
$1,976.53
|
| Rate for Payer: Ambetter Exchange |
$1,236.40
|
| Rate for Payer: Anthem Medicaid |
$816.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,236.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,236.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,483.68
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,943.80
|
| Rate for Payer: Healthspan PPO |
$1,913.79
|
| Rate for Payer: Humana Medicaid |
$816.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,712.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,236.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,236.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$833.09
|
| Rate for Payer: Molina Healthcare Passport |
$816.75
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,607.32
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$824.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,236.40
|
|
|
LAPARO-VAG HYST W/T/O COMPL
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58554
|
| Hospital Charge Code |
76102232
|
|
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
|
|
|
LAPARO-VAG HYST W/T/O COMPL
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58554
|
| Hospital Charge Code |
76102232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| 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 |
$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 |
$9,619.76
|
| 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 |
$11,543.71
|
| 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
|
|
|
LAPARO-VAG HYST W/T/O COMPL(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58554
|
| Hospital Charge Code |
761P2232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$1,976.53 |
| Rate for Payer: Aetna Commercial |
$1,976.53
|
| Rate for Payer: Ambetter Exchange |
$1,236.40
|
| Rate for Payer: Anthem Medicaid |
$816.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,236.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,236.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,483.68
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,943.80
|
| Rate for Payer: Healthspan PPO |
$1,913.79
|
| Rate for Payer: Humana Medicaid |
$816.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,712.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,236.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,236.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$833.09
|
| Rate for Payer: Molina Healthcare Passport |
$816.75
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,607.32
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$824.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,236.40
|
|
|
LAPBAND ADJUSTMENT
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
51000148
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
LAPBAND ADJUSTMENT
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
51000148
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$51.59
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$52.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
LAPBAND ADJUSTMENT
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
51000148
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$32.74
|
| Rate for Payer: Ambetter Exchange |
$32.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.82
|
| Rate for Payer: Anthem Medicaid |
$30.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.06
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$52.96
|
| Rate for Payer: Humana Medicaid |
$30.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.14
|
| Rate for Payer: Molina Healthcare Passport |
$30.53
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.31
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.55
|
|
|
LAP BIL TUBAL
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58670
|
| Hospital Charge Code |
76102251
|
|
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
|
|
|
LAP BIL TUBAL
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58670
|
| Hospital Charge Code |
76102251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.12 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$551.91
|
| Rate for Payer: Ambetter Exchange |
$351.59
|
| Rate for Payer: Anthem Medicaid |
$280.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$351.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$351.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.91
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$538.71
|
| Rate for Payer: Healthspan PPO |
$534.39
|
| Rate for Payer: Humana Medicaid |
$280.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$474.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$351.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.72
|
| Rate for Payer: Molina Healthcare Passport |
$280.12
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$457.07
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$351.59
|
|
|
LAP BIL TUBAL
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58670
|
| Hospital Charge Code |
76102251
|
|
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
|
|
|
LAP BIL TUBAL(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58670
|
| Hospital Charge Code |
761P2251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.12 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$551.91
|
| Rate for Payer: Ambetter Exchange |
$351.59
|
| Rate for Payer: Anthem Medicaid |
$280.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$351.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$351.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.91
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$538.71
|
| Rate for Payer: Healthspan PPO |
$534.39
|
| Rate for Payer: Humana Medicaid |
$280.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$474.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$351.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.72
|
| Rate for Payer: Molina Healthcare Passport |
$280.12
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$457.07
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$351.59
|
|
|
LAP CHOLECYSTECTOMY
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47564
|
| Hospital Charge Code |
76101966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,238.04 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| 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 |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Humana Medicare Advantage |
$9,619.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,543.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LAP CHOLECYSTECTOMY
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47564
|
| Hospital Charge Code |
76101966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.69 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,261.01
|
| Rate for Payer: Ambetter Exchange |
$1,067.73
|
| Rate for Payer: Anthem Medicaid |
$667.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,067.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,067.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,281.28
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$1,182.57
|
| Rate for Payer: Healthspan PPO |
$1,063.44
|
| Rate for Payer: Humana Medicaid |
$667.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,102.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,067.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,067.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$681.04
|
| Rate for Payer: Molina Healthcare Passport |
$667.69
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,388.05
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$674.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,067.73
|
|
|
LAP CHOLECYSTECTOMY
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47564
|
| Hospital Charge Code |
76101966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,080.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LAP CHOLECYSTECTOMY(P
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 47564
|
| Hospital Charge Code |
761P1966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.69 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,261.01
|
| Rate for Payer: Ambetter Exchange |
$1,067.73
|
| Rate for Payer: Anthem Medicaid |
$667.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,067.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,067.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,281.28
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$1,182.57
|
| Rate for Payer: Healthspan PPO |
$1,063.44
|
| Rate for Payer: Humana Medicaid |
$667.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,102.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,067.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,067.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$681.04
|
| Rate for Payer: Molina Healthcare Passport |
$667.69
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,388.05
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$674.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,067.73
|
|
|
LAP CHOLECYSTECTOMY W/CHOLANGI
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
76101965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
LAP CHOLECYSTECTOMY W/CHOLANGI
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
76101965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,088.48 |
| Rate for Payer: Aetna Commercial |
$1,088.48
|
| Rate for Payer: Ambetter Exchange |
$687.11
|
| Rate for Payer: Anthem Medicaid |
$562.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$687.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$687.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$824.53
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$1,017.30
|
| Rate for Payer: Healthspan PPO |
$917.93
|
| Rate for Payer: Humana Medicaid |
$562.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$959.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$687.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$573.48
|
| Rate for Payer: Molina Healthcare Passport |
$562.24
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$893.24
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$567.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$687.11
|
|
|
LAP CHOLECYSTECTOMY W/CHOLANGI
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
761P1965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,088.48 |
| Rate for Payer: Aetna Commercial |
$1,088.48
|
| Rate for Payer: Ambetter Exchange |
$687.11
|
| Rate for Payer: Anthem Medicaid |
$562.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$687.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$687.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$824.53
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$1,017.30
|
| Rate for Payer: Healthspan PPO |
$917.93
|
| Rate for Payer: Humana Medicaid |
$562.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$959.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$687.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$573.48
|
| Rate for Payer: Molina Healthcare Passport |
$562.24
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$893.24
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$567.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$687.11
|
|
|
LAP CHOLECYSTECTOMY W/CHOLANGI
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
76101965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
