|
LAP ILEO/JEJUNO-STOMY
|
Facility
|
IP
|
$2,688.00
|
|
|
Service Code
|
HCPCS 44187
|
| Hospital Charge Code |
76102926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.40 |
| Max. Negotiated Rate |
$2,580.48 |
| Rate for Payer: Aetna Commercial |
$2,069.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,096.64
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cigna Commercial |
$2,231.04
|
| Rate for Payer: First Health Commercial |
$2,553.60
|
| Rate for Payer: Humana Commercial |
$2,284.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,204.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,983.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$806.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,365.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,016.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,150.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,338.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,854.72
|
| Rate for Payer: PHCS Commercial |
$2,580.48
|
| Rate for Payer: United Healthcare All Payer |
$2,365.44
|
|
|
LAP ILEO/JEJUNO-STOMY
|
Professional
|
Both
|
$2,688.00
|
|
|
Service Code
|
HCPCS 44187
|
| Hospital Charge Code |
76102926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$734.68 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,576.47
|
| Rate for Payer: Ambetter Exchange |
$1,026.24
|
| Rate for Payer: Anthem Medicaid |
$734.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,026.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,026.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,231.49
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cigna Commercial |
$1,482.90
|
| Rate for Payer: Healthspan PPO |
$1,329.47
|
| Rate for Payer: Humana Medicaid |
$734.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,396.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,026.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$749.37
|
| Rate for Payer: Molina Healthcare Passport |
$734.68
|
| Rate for Payer: Multiplan PHCS |
$1,612.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,334.11
|
| Rate for Payer: UHCCP Medicaid |
$940.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$742.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,026.24
|
|
|
LAP ILEO/JEJUNO-STOMY
|
Facility
|
OP
|
$2,688.00
|
|
|
Service Code
|
HCPCS 44187
|
| Hospital Charge Code |
76102926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.40 |
| Max. Negotiated Rate |
$2,580.48 |
| Rate for Payer: Aetna Commercial |
$2,069.76
|
| Rate for Payer: Anthem Medicaid |
$924.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,096.64
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cigna Commercial |
$2,231.04
|
| Rate for Payer: First Health Commercial |
$2,553.60
|
| Rate for Payer: Humana Commercial |
$2,284.80
|
| Rate for Payer: Humana KY Medicaid |
$924.40
|
| Rate for Payer: Kentucky WC Medicaid |
$933.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,204.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,983.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$806.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$942.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,365.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,016.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,150.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,338.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,854.72
|
| Rate for Payer: PHCS Commercial |
$2,580.48
|
| Rate for Payer: United Healthcare All Payer |
$2,365.44
|
|
|
LAP INIT INGUIN HERN REPR
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
76102032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.66 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem Medicaid |
$357.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| 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 |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Humana KY Medicaid |
$357.66
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$361.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$364.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.60
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
LAP INIT INGUIN HERN REPR
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
76102032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.13 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$610.25
|
| Rate for Payer: Ambetter Exchange |
$414.15
|
| Rate for Payer: Anthem Medicaid |
$302.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$414.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$414.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$496.98
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$565.57
|
| Rate for Payer: Healthspan PPO |
$514.63
|
| Rate for Payer: Humana Medicaid |
$302.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$536.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$414.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$414.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.17
|
| Rate for Payer: Molina Healthcare Passport |
$302.13
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$538.39
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.15
|
|
|
LAP INIT INGUIN HERN REPR
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
76102032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$998.40 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.60
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
LAP INIT INGUIN HERN REPR(P
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
761P2032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.13 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$610.25
|
| Rate for Payer: Ambetter Exchange |
$414.15
|
| Rate for Payer: Anthem Medicaid |
$302.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$414.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$414.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$496.98
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$565.57
|
| Rate for Payer: Healthspan PPO |
$514.63
|
| Rate for Payer: Humana Medicaid |
$302.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$536.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$414.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$414.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.17
|
| Rate for Payer: Molina Healthcare Passport |
$302.13
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$538.39
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.15
|
|
|
LAP INSERTION PERM IP CATH
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 49324
|
| Hospital Charge Code |
76101991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
LAP INSERTION PERM IP CATH
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 49324
|
| Hospital Charge Code |
76101991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$566.47 |
| Rate for Payer: Aetna Commercial |
$566.47
|
| Rate for Payer: Ambetter Exchange |
$367.98
|
| Rate for Payer: Anthem Medicaid |
$270.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$441.58
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$528.76
|
| Rate for Payer: Healthspan PPO |
$477.71
|
| Rate for Payer: Humana Medicaid |
$270.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$503.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.49
|
| Rate for Payer: Molina Healthcare Passport |
$270.09
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$478.37
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.98
|
|
|
LAP INSERTION PERM IP CATH
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 49324
|
| Hospital Charge Code |
76101991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
LAP INSERTION PERM IP CATH(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 49324
|
| Hospital Charge Code |
761P1991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$566.47 |
| Rate for Payer: Aetna Commercial |
$566.47
|
| Rate for Payer: Ambetter Exchange |
$367.98
|
| Rate for Payer: Anthem Medicaid |
$270.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$441.58
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$528.76
|
| Rate for Payer: Healthspan PPO |
$477.71
|
| Rate for Payer: Humana Medicaid |
$270.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$503.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.49
|
| Rate for Payer: Molina Healthcare Passport |
$270.09
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$478.37
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.98
|
|
|
LAPIPLASTY SYSTEM 4
|
Facility
|
IP
|
$23,731.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,119.38 |
| Max. Negotiated Rate |
$22,782.00 |
| Rate for Payer: Aetna Commercial |
$18,273.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,510.38
|
| Rate for Payer: Cash Price |
$11,865.62
|
| Rate for Payer: Cigna Commercial |
$19,696.94
|
| Rate for Payer: First Health Commercial |
$22,544.69
|
| Rate for Payer: Humana Commercial |
$20,171.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,459.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,513.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,119.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,883.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,798.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,646.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,374.56
|
| Rate for Payer: PHCS Commercial |
$22,782.00
|
| Rate for Payer: United Healthcare All Payer |
$20,883.50
|
|
|
LAPIPLASTY SYSTEM 4
|
Facility
|
OP
|
$23,731.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,119.38 |
| Max. Negotiated Rate |
$22,782.00 |
| Rate for Payer: Aetna Commercial |
$18,273.06
|
| Rate for Payer: Anthem Medicaid |
$8,161.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,510.38
|
| Rate for Payer: Cash Price |
$11,865.62
|
| Rate for Payer: Cigna Commercial |
$19,696.94
|
| Rate for Payer: First Health Commercial |
$22,544.69
|
| Rate for Payer: Humana Commercial |
$20,171.56
|
| Rate for Payer: Humana KY Medicaid |
$8,161.18
|
| Rate for Payer: Kentucky WC Medicaid |
$8,244.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,459.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,513.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,119.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,324.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,883.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,798.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,646.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,374.56
|
| Rate for Payer: PHCS Commercial |
$22,782.00
|
| Rate for Payer: United Healthcare All Payer |
$20,883.50
|
|
|
LAPIPLASTY�� SPEEDPLATE���
|
Facility
|
OP
|
$16,883.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.14 |
| Max. Negotiated Rate |
$16,208.45 |
| Rate for Payer: Aetna Commercial |
$13,000.53
|
| Rate for Payer: Anthem Medicaid |
$5,806.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,169.36
|
| Rate for Payer: Cash Price |
$8,441.90
|
| Rate for Payer: Cigna Commercial |
$14,013.55
|
| Rate for Payer: First Health Commercial |
$16,039.61
|
| Rate for Payer: Humana Commercial |
$14,351.23
|
| Rate for Payer: Humana KY Medicaid |
$5,806.34
|
| Rate for Payer: Kentucky WC Medicaid |
$5,865.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,844.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,460.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,922.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,857.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,507.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,688.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,649.82
|
| Rate for Payer: PHCS Commercial |
$16,208.45
|
| Rate for Payer: United Healthcare All Payer |
$14,857.74
|
|
|
LAPIPLASTY�� SPEEDPLATE���
|
Facility
|
IP
|
$16,883.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.14 |
| Max. Negotiated Rate |
$16,208.45 |
| Rate for Payer: Aetna Commercial |
$13,000.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,169.36
|
| Rate for Payer: Cash Price |
$8,441.90
|
| Rate for Payer: Cigna Commercial |
$14,013.55
|
| Rate for Payer: First Health Commercial |
$16,039.61
|
| Rate for Payer: Humana Commercial |
$14,351.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,844.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,460.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,857.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,507.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,688.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,649.82
|
| Rate for Payer: PHCS Commercial |
$16,208.45
|
| Rate for Payer: United Healthcare All Payer |
$14,857.74
|
|
|
LAPIPLASTY�� SPEEDPLATE��� 28X13X
|
Facility
|
OP
|
$17,808.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,342.64 |
| Max. Negotiated Rate |
$17,096.45 |
| Rate for Payer: Aetna Commercial |
$13,712.78
|
| Rate for Payer: Anthem Medicaid |
$6,124.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,890.86
|
| Rate for Payer: Cash Price |
$8,904.40
|
| Rate for Payer: Cigna Commercial |
$14,781.30
|
| Rate for Payer: First Health Commercial |
$16,918.36
|
| Rate for Payer: Humana Commercial |
$15,137.48
|
| Rate for Payer: Humana KY Medicaid |
$6,124.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,186.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,603.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,142.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,342.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,247.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,671.74
|
| Rate for Payer: Ohio Health Group HMO |
$13,356.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,247.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,493.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,288.07
|
| Rate for Payer: PHCS Commercial |
$17,096.45
|
| Rate for Payer: United Healthcare All Payer |
$15,671.74
|
|
|
LAPIPLASTY�� SPEEDPLATE��� 28X13X
|
Facility
|
IP
|
$17,808.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,342.64 |
| Max. Negotiated Rate |
$17,096.45 |
| Rate for Payer: Aetna Commercial |
$13,712.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,890.86
|
| Rate for Payer: Cash Price |
$8,904.40
|
| Rate for Payer: Cigna Commercial |
$14,781.30
|
| Rate for Payer: First Health Commercial |
$16,918.36
|
| Rate for Payer: Humana Commercial |
$15,137.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,603.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,142.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,342.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,671.74
|
| Rate for Payer: Ohio Health Group HMO |
$13,356.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,247.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,493.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,288.07
|
| Rate for Payer: PHCS Commercial |
$17,096.45
|
| Rate for Payer: United Healthcare All Payer |
$15,671.74
|
|
|
LAP MOBILIZATION SPLENIC FLE(P
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 44213
|
| Hospital Charge Code |
761P1832
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.37 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Aetna Commercial |
$286.90
|
| Rate for Payer: Ambetter Exchange |
$176.13
|
| Rate for Payer: Anthem Medicaid |
$146.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$176.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$176.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$211.36
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$273.79
|
| Rate for Payer: Healthspan PPO |
$241.95
|
| Rate for Payer: Humana Medicaid |
$146.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$244.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$176.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.30
|
| Rate for Payer: Molina Healthcare Passport |
$146.37
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.97
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$176.13
|
|
|
LAP MOBILIZATION SPLENIC FLEX
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 44213
|
| Hospital Charge Code |
76101832
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.37 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Aetna Commercial |
$286.90
|
| Rate for Payer: Ambetter Exchange |
$176.13
|
| Rate for Payer: Anthem Medicaid |
$146.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$176.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$176.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$211.36
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$273.79
|
| Rate for Payer: Healthspan PPO |
$241.95
|
| Rate for Payer: Humana Medicaid |
$146.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$244.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$176.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.30
|
| Rate for Payer: Molina Healthcare Passport |
$146.37
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.97
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$176.13
|
|
|
LAP MOBILIZATION SPLENIC FLEX
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 44213
|
| Hospital Charge Code |
76101832
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.60
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
LAP MOBILIZATION SPLENIC FLEX
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 44213
|
| Hospital Charge Code |
76101832
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$151.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.60
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
LAP MYOTOMY HELLER
|
Facility
|
OP
|
$1,515.00
|
|
|
Service Code
|
HCPCS 43279
|
| Hospital Charge Code |
76101763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$454.50 |
| Max. Negotiated Rate |
$1,454.40 |
| Rate for Payer: Aetna Commercial |
$1,166.55
|
| Rate for Payer: Anthem Medicaid |
$521.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,181.70
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cigna Commercial |
$1,257.45
|
| Rate for Payer: First Health Commercial |
$1,439.25
|
| Rate for Payer: Humana Commercial |
$1,287.75
|
| Rate for Payer: Humana KY Medicaid |
$521.01
|
| Rate for Payer: Kentucky WC Medicaid |
$526.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$531.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,318.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,045.35
|
| Rate for Payer: PHCS Commercial |
$1,454.40
|
| Rate for Payer: United Healthcare All Payer |
$1,333.20
|
|
|
LAP MYOTOMY HELLER
|
Facility
|
IP
|
$1,515.00
|
|
|
Service Code
|
HCPCS 43279
|
| Hospital Charge Code |
76101763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$454.50 |
| Max. Negotiated Rate |
$1,454.40 |
| Rate for Payer: Aetna Commercial |
$1,166.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,181.70
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cigna Commercial |
$1,257.45
|
| Rate for Payer: First Health Commercial |
$1,439.25
|
| Rate for Payer: Humana Commercial |
$1,287.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,318.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,045.35
|
| Rate for Payer: PHCS Commercial |
$1,454.40
|
| Rate for Payer: United Healthcare All Payer |
$1,333.20
|
|
|
LAP MYOTOMY HELLER
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 43279
|
| Hospital Charge Code |
76101763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.25 |
| Max. Negotiated Rate |
$1,892.35 |
| Rate for Payer: Aetna Commercial |
$1,888.47
|
| Rate for Payer: Ambetter Exchange |
$1,220.89
|
| Rate for Payer: Anthem Medicaid |
$969.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,220.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,220.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,465.07
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cigna Commercial |
$1,892.35
|
| Rate for Payer: Healthspan PPO |
$1,592.58
|
| Rate for Payer: Humana Medicaid |
$969.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,666.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,220.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,220.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$989.31
|
| Rate for Payer: Molina Healthcare Passport |
$969.91
|
| Rate for Payer: Multiplan PHCS |
$909.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,587.16
|
| Rate for Payer: UHCCP Medicaid |
$530.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$979.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,220.89
|
|
|
LAP MYOTOMY HELLER(P
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 43279
|
| Hospital Charge Code |
761P1763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.25 |
| Max. Negotiated Rate |
$1,892.35 |
| Rate for Payer: Aetna Commercial |
$1,888.47
|
| Rate for Payer: Ambetter Exchange |
$1,220.89
|
| Rate for Payer: Anthem Medicaid |
$969.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,220.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,220.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,465.07
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cigna Commercial |
$1,892.35
|
| Rate for Payer: Healthspan PPO |
$1,592.58
|
| Rate for Payer: Humana Medicaid |
$969.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,666.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,220.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,220.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$989.31
|
| Rate for Payer: Molina Healthcare Passport |
$969.91
|
| Rate for Payer: Multiplan PHCS |
$909.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,587.16
|
| Rate for Payer: UHCCP Medicaid |
$530.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$979.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,220.89
|
|
