|
LAP W/BIOPSY
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
76101988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.28 |
| Max. Negotiated Rate |
$502.29 |
| Rate for Payer: Aetna Commercial |
$502.29
|
| Rate for Payer: Ambetter Exchange |
$328.37
|
| Rate for Payer: Anthem Medicaid |
$275.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$328.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$328.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$394.04
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$470.49
|
| Rate for Payer: Healthspan PPO |
$423.59
|
| Rate for Payer: Humana Medicaid |
$275.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$442.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$328.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$280.79
|
| Rate for Payer: Molina Healthcare Passport |
$275.28
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$426.88
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$278.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$328.37
|
|
|
LAP W/BIOPSY
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
76101988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
LAP W/BIOPSY
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
76101988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
LAP W/BIOPSY(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
761P1988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.28 |
| Max. Negotiated Rate |
$502.29 |
| Rate for Payer: Aetna Commercial |
$502.29
|
| Rate for Payer: Ambetter Exchange |
$328.37
|
| Rate for Payer: Anthem Medicaid |
$275.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$328.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$328.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$394.04
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$470.49
|
| Rate for Payer: Healthspan PPO |
$423.59
|
| Rate for Payer: Humana Medicaid |
$275.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$442.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$328.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$280.79
|
| Rate for Payer: Molina Healthcare Passport |
$275.28
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$426.88
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$278.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$328.37
|
|
|
LAP W/BSO
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
76102249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
LAP W/BSO
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
76102249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$503.77 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$985.37
|
| Rate for Payer: Ambetter Exchange |
$619.25
|
| Rate for Payer: Anthem Medicaid |
$503.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$619.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$619.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$743.10
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$967.27
|
| Rate for Payer: Healthspan PPO |
$954.09
|
| Rate for Payer: Humana Medicaid |
$503.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$838.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$619.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$513.85
|
| Rate for Payer: Molina Healthcare Passport |
$503.77
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$805.02
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$508.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$619.25
|
|
|
LAP W/BSO
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
76102249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$859.75 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| 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 |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
LAP W/BSO(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
761P2249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$503.77 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$985.37
|
| Rate for Payer: Ambetter Exchange |
$619.25
|
| Rate for Payer: Anthem Medicaid |
$503.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$619.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$619.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$743.10
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$967.27
|
| Rate for Payer: Healthspan PPO |
$954.09
|
| Rate for Payer: Humana Medicaid |
$503.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$838.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$619.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$513.85
|
| Rate for Payer: Molina Healthcare Passport |
$503.77
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$805.02
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$508.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$619.25
|
|
|
LAP W/BTS
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 58671
|
| Hospital Charge Code |
76102252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
LAP W/BTS
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 58671
|
| Hospital Charge Code |
76102252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
LAP W/BTS
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 58671
|
| Hospital Charge Code |
76102252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$552.09 |
| Rate for Payer: Aetna Commercial |
$552.09
|
| Rate for Payer: Ambetter Exchange |
$351.59
|
| Rate for Payer: Anthem Medicaid |
$287.90
|
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$539.30
|
| Rate for Payer: Healthspan PPO |
$534.56
|
| Rate for Payer: Humana Medicaid |
$287.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$473.91
|
| 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 |
$293.66
|
| Rate for Payer: Molina Healthcare Passport |
$287.90
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$457.07
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$351.59
|
|
|
LAP W/BTS(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 58671
|
| Hospital Charge Code |
761P2252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$552.09 |
| Rate for Payer: Aetna Commercial |
$552.09
|
| Rate for Payer: Ambetter Exchange |
$351.59
|
| Rate for Payer: Anthem Medicaid |
$287.90
|
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$539.30
|
| Rate for Payer: Healthspan PPO |
$534.56
|
| Rate for Payer: Humana Medicaid |
$287.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$473.91
|
| 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 |
$293.66
|
| Rate for Payer: Molina Healthcare Passport |
$287.90
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$457.07
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$351.59
|
|
|
LAP W/ECTOPIC PREGNANCY
|
Professional
|
Both
|
$9,118.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
72000009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$333.06 |
| Max. Negotiated Rate |
$5,470.80 |
| Rate for Payer: Aetna Commercial |
$1,259.83
|
| Rate for Payer: Ambetter Exchange |
$755.85
|
| Rate for Payer: Anthem Medicaid |
$333.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$755.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$755.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$907.02
|
| Rate for Payer: Cash Price |
$4,559.00
|
| Rate for Payer: Cash Price |
$4,559.00
|
| Rate for Payer: Cigna Commercial |
$1,154.38
|
| Rate for Payer: Healthspan PPO |
$914.40
|
| Rate for Payer: Humana Medicaid |
$333.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,021.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$755.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$755.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.72
|
| Rate for Payer: Molina Healthcare Passport |
$333.06
|
| Rate for Payer: Multiplan PHCS |
$5,470.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$982.61
|
| Rate for Payer: UHCCP Medicaid |
$3,191.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$755.85
|
|
|
LAP W/ECTOPIC PREGNANCY
|
Facility
|
OP
|
$9,118.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
72000009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$3,135.68 |
| Max. Negotiated Rate |
$8,753.28 |
| Rate for Payer: Aetna Commercial |
$7,020.86
|
| Rate for Payer: Anthem Medicaid |
$3,135.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,112.04
|
| 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 |
$4,559.00
|
| Rate for Payer: Cash Price |
$4,559.00
|
| Rate for Payer: Cigna Commercial |
$7,567.94
|
| Rate for Payer: First Health Commercial |
$8,662.10
|
| Rate for Payer: Humana Commercial |
$7,750.30
|
| Rate for Payer: Humana KY Medicaid |
$3,135.68
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,167.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,476.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,729.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,198.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,023.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,838.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,294.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,932.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,291.42
|
| Rate for Payer: PHCS Commercial |
$8,753.28
|
| Rate for Payer: United Healthcare All Payer |
$8,023.84
|
|
|
LAP W/ECTOPIC PREGNANCY
|
Facility
|
IP
|
$9,118.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
72000009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,735.40 |
| Max. Negotiated Rate |
$8,753.28 |
| Rate for Payer: Aetna Commercial |
$7,020.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,112.04
|
| Rate for Payer: Cash Price |
$4,559.00
|
| Rate for Payer: Cigna Commercial |
$7,567.94
|
| Rate for Payer: First Health Commercial |
$8,662.10
|
| Rate for Payer: Humana Commercial |
$7,750.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,476.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,729.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,735.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,023.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,838.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,294.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,932.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,291.42
|
| Rate for Payer: PHCS Commercial |
$8,753.28
|
| Rate for Payer: United Healthcare All Payer |
$8,023.84
|
|
|
LAP W/ECTOPIC PREGNANCY(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
720P0009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$333.06 |
| Max. Negotiated Rate |
$1,259.83 |
| Rate for Payer: Aetna Commercial |
$1,259.83
|
| Rate for Payer: Ambetter Exchange |
$755.85
|
| Rate for Payer: Anthem Medicaid |
$333.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$755.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$755.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$907.02
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,154.38
|
| Rate for Payer: Healthspan PPO |
$914.40
|
| Rate for Payer: Humana Medicaid |
$333.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,021.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$755.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$755.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.72
|
| Rate for Payer: Molina Healthcare Passport |
$333.06
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$982.61
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$755.85
|
|
|
LAP W/ECTOPIC PREGNANCY(T
|
Facility
|
IP
|
$7,218.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
720T0009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,165.40 |
| Max. Negotiated Rate |
$6,929.28 |
| Rate for Payer: Aetna Commercial |
$5,557.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,630.04
|
| Rate for Payer: Cash Price |
$3,609.00
|
| Rate for Payer: Cigna Commercial |
$5,990.94
|
| Rate for Payer: First Health Commercial |
$6,857.10
|
| Rate for Payer: Humana Commercial |
$6,135.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,918.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,326.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,351.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,413.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,774.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,279.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,980.42
|
| Rate for Payer: PHCS Commercial |
$6,929.28
|
| Rate for Payer: United Healthcare All Payer |
$6,351.84
|
|
|
LAP W/ECTOPIC PREGNANCY(T
|
Facility
|
OP
|
$7,218.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
720T0009
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,482.27 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$5,557.86
|
| Rate for Payer: Anthem Medicaid |
$2,482.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,630.04
|
| 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 |
$3,609.00
|
| Rate for Payer: Cash Price |
$3,609.00
|
| Rate for Payer: Cigna Commercial |
$5,990.94
|
| Rate for Payer: First Health Commercial |
$6,857.10
|
| Rate for Payer: Humana Commercial |
$6,135.30
|
| Rate for Payer: Humana KY Medicaid |
$2,482.27
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,507.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,918.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,326.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,351.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,413.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,774.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,279.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,980.42
|
| Rate for Payer: PHCS Commercial |
$6,929.28
|
| Rate for Payer: United Healthcare All Payer |
$6,351.84
|
|
|
LAP WEDGE RESEC GASTRIC ULCER
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
76103036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
LAP W/OMENTOPEXY ADD-ON
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 49326
|
| Hospital Charge Code |
76101992
|
|
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 W/OMENTOPEXY ADD-ON
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 49326
|
| Hospital Charge Code |
76101992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.28 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Aetna Commercial |
$284.23
|
| Rate for Payer: Ambetter Exchange |
$178.82
|
| Rate for Payer: Anthem Medicaid |
$135.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$178.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$178.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.58
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$261.63
|
| Rate for Payer: Healthspan PPO |
$239.69
|
| Rate for Payer: Humana Medicaid |
$135.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$245.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$178.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.99
|
| Rate for Payer: Molina Healthcare Passport |
$135.28
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$232.47
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$178.82
|
|
|
LAP W/OMENTOPEXY ADD-ON
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 49326
|
| Hospital Charge Code |
76101992
|
|
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 W/OMENTOPEXY ADD-ON(P
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 49326
|
| Hospital Charge Code |
761P1992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.28 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Aetna Commercial |
$284.23
|
| Rate for Payer: Ambetter Exchange |
$178.82
|
| Rate for Payer: Anthem Medicaid |
$135.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$178.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$178.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.58
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$261.63
|
| Rate for Payer: Healthspan PPO |
$239.69
|
| Rate for Payer: Humana Medicaid |
$135.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$245.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$178.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.99
|
| Rate for Payer: Molina Healthcare Passport |
$135.28
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$232.47
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$178.82
|
|
|
LAP W/ S/O
|
Professional
|
Both
|
$12,709.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
72000010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$458.93 |
| Max. Negotiated Rate |
$7,625.40 |
| Rate for Payer: Aetna Commercial |
$1,231.70
|
| Rate for Payer: Ambetter Exchange |
$739.18
|
| Rate for Payer: Anthem Medicaid |
$458.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$739.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$739.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$887.02
|
| Rate for Payer: Cash Price |
$6,354.50
|
| Rate for Payer: Cash Price |
$6,354.50
|
| Rate for Payer: Cigna Commercial |
$1,139.52
|
| Rate for Payer: Healthspan PPO |
$893.99
|
| Rate for Payer: Humana Medicaid |
$458.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$997.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$739.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$739.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.11
|
| Rate for Payer: Molina Healthcare Passport |
$458.93
|
| Rate for Payer: Multiplan PHCS |
$7,625.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$960.93
|
| Rate for Payer: UHCCP Medicaid |
$4,448.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$739.18
|
|
|
LAP W/ S/O
|
Facility
|
OP
|
$12,709.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
72000010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$4,370.63 |
| Max. Negotiated Rate |
$12,200.64 |
| Rate for Payer: Aetna Commercial |
$9,785.93
|
| Rate for Payer: Anthem Medicaid |
$4,370.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,913.02
|
| 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 |
$6,354.50
|
| Rate for Payer: Cash Price |
$6,354.50
|
| Rate for Payer: Cigna Commercial |
$10,548.47
|
| Rate for Payer: First Health Commercial |
$12,073.55
|
| Rate for Payer: Humana Commercial |
$10,802.65
|
| Rate for Payer: Humana KY Medicaid |
$4,370.63
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,415.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,421.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,379.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,458.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,183.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,531.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,056.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,769.21
|
| Rate for Payer: PHCS Commercial |
$12,200.64
|
| Rate for Payer: United Healthcare All Payer |
$11,183.92
|
|
