|
LAP W/ S/O
|
Facility
|
IP
|
$12,709.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
72000010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$3,812.70 |
| Max. Negotiated Rate |
$12,200.64 |
| Rate for Payer: Aetna Commercial |
$9,785.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,913.02
|
| 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: 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 |
$3,812.70
|
| 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
|
|
|
LAP W/ S/O(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
720P0010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$458.93 |
| Max. Negotiated Rate |
$1,380.00 |
| 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 |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| 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 |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$960.93
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$739.18
|
|
|
LAP W/ S/O(T
|
Facility
|
IP
|
$10,409.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
720T0010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$3,122.70 |
| Max. Negotiated Rate |
$9,992.64 |
| Rate for Payer: Aetna Commercial |
$8,014.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,119.02
|
| Rate for Payer: Cash Price |
$5,204.50
|
| Rate for Payer: Cigna Commercial |
$8,639.47
|
| Rate for Payer: First Health Commercial |
$9,888.55
|
| Rate for Payer: Humana Commercial |
$8,847.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,535.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,681.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,122.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,159.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,806.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,327.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,055.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,182.21
|
| Rate for Payer: PHCS Commercial |
$9,992.64
|
| Rate for Payer: United Healthcare All Payer |
$9,159.92
|
|
|
LAP W/ S/O(T
|
Facility
|
OP
|
$10,409.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
720T0010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$3,579.66 |
| Max. Negotiated Rate |
$9,992.64 |
| Rate for Payer: Aetna Commercial |
$8,014.93
|
| Rate for Payer: Anthem Medicaid |
$3,579.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,119.02
|
| 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 |
$5,204.50
|
| Rate for Payer: Cash Price |
$5,204.50
|
| Rate for Payer: Cigna Commercial |
$8,639.47
|
| Rate for Payer: First Health Commercial |
$9,888.55
|
| Rate for Payer: Humana Commercial |
$8,847.65
|
| Rate for Payer: Humana KY Medicaid |
$3,579.66
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,616.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,535.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,681.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,651.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,159.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,806.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,327.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,055.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,182.21
|
| Rate for Payer: PHCS Commercial |
$9,992.64
|
| Rate for Payer: United Healthcare All Payer |
$9,159.92
|
|
|
LAP W/UNA
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58662
|
| Hospital Charge Code |
76102250
|
|
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/UNA
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58662
|
| Hospital Charge Code |
76102250
|
|
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/UNA
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58662
|
| Hospital Charge Code |
76102250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.04 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,075.88
|
| Rate for Payer: Ambetter Exchange |
$676.70
|
| Rate for Payer: Anthem Medicaid |
$507.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$676.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$676.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$812.04
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,053.93
|
| Rate for Payer: Healthspan PPO |
$1,041.72
|
| Rate for Payer: Humana Medicaid |
$507.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$917.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$676.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$676.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$517.18
|
| Rate for Payer: Molina Healthcare Passport |
$507.04
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$879.71
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$512.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$676.70
|
|
|
LAP W/UNA(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58662
|
| Hospital Charge Code |
761P2250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.04 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,075.88
|
| Rate for Payer: Ambetter Exchange |
$676.70
|
| Rate for Payer: Anthem Medicaid |
$507.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$676.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$676.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$812.04
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,053.93
|
| Rate for Payer: Healthspan PPO |
$1,041.72
|
| Rate for Payer: Humana Medicaid |
$507.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$917.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$676.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$676.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$517.18
|
| Rate for Payer: Molina Healthcare Passport |
$507.04
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$879.71
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$512.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$676.70
|
|
|
LAP W/UTERINE SUSPENSION
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58400
|
| Hospital Charge Code |
76102226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
LAP W/UTERINE SUSPENSION
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58400
|
| Hospital Charge Code |
76102226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.55 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$673.45
|
| Rate for Payer: Ambetter Exchange |
$434.89
|
| Rate for Payer: Anthem Medicaid |
$345.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$434.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$434.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$521.87
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$648.96
|
| Rate for Payer: Healthspan PPO |
$652.07
|
| Rate for Payer: Humana Medicaid |
$345.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$434.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$434.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$352.46
|
| Rate for Payer: Molina Healthcare Passport |
$345.55
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$565.36
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$349.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$434.89
|
|
|
LAP W/UTERINE SUSPENSION
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58400
|
| Hospital Charge Code |
76102226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
LAP W/UTERINE SUSPENSION(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58400
|
| Hospital Charge Code |
761P2226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.55 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$673.45
|
| Rate for Payer: Ambetter Exchange |
$434.89
|
| Rate for Payer: Anthem Medicaid |
$345.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$434.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$434.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$521.87
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$648.96
|
| Rate for Payer: Healthspan PPO |
$652.07
|
| Rate for Payer: Humana Medicaid |
$345.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$434.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$434.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$352.46
|
| Rate for Payer: Molina Healthcare Passport |
$345.55
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$565.36
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$349.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$434.89
|
|
|
LAP W/VAGINAL HYSTERECTOMY
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 58552
|
| Hospital Charge Code |
76102231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$640.10 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,475.07
|
| Rate for Payer: Ambetter Exchange |
$931.09
|
| Rate for Payer: Anthem Medicaid |
$640.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$931.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$931.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,117.31
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,448.17
|
| Rate for Payer: Healthspan PPO |
$1,428.25
|
| Rate for Payer: Humana Medicaid |
$640.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,275.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$931.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$652.90
|
| Rate for Payer: Molina Healthcare Passport |
$640.10
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,210.42
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$646.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$931.09
|
|
|
LAP W/VAGINAL HYSTERECTOMY
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 58552
|
| Hospital Charge Code |
76102231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
LAP W/VAGINAL HYSTERECTOMY
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 58552
|
| Hospital Charge Code |
76102231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,100.48 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| 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 |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Humana Medicare Advantage |
$9,619.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,543.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
LAP W/VAGINAL HYSTERECTOMY(P
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 58552
|
| Hospital Charge Code |
761P2231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$640.10 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,475.07
|
| Rate for Payer: Ambetter Exchange |
$931.09
|
| Rate for Payer: Anthem Medicaid |
$640.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$931.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$931.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,117.31
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,448.17
|
| Rate for Payer: Healthspan PPO |
$1,428.25
|
| Rate for Payer: Humana Medicaid |
$640.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,275.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$931.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$652.90
|
| Rate for Payer: Molina Healthcare Passport |
$640.10
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,210.42
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$646.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$931.09
|
|
|
LARYNGEAL FUNCTION STUDIES
|
Facility
|
IP
|
$419.75
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
76102452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.92 |
| Max. Negotiated Rate |
$402.96 |
| Rate for Payer: Aetna Commercial |
$323.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.40
|
| Rate for Payer: Cash Price |
$209.88
|
| Rate for Payer: Cigna Commercial |
$348.39
|
| Rate for Payer: First Health Commercial |
$398.76
|
| Rate for Payer: Humana Commercial |
$356.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.38
|
| Rate for Payer: Ohio Health Group HMO |
$314.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.63
|
| Rate for Payer: PHCS Commercial |
$402.96
|
| Rate for Payer: United Healthcare All Payer |
$369.38
|
|
|
LARYNGEAL FUNCTION STUDIES
|
Professional
|
Both
|
$419.75
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
76102452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.07 |
| Max. Negotiated Rate |
$251.85 |
| Rate for Payer: Aetna Commercial |
$39.62
|
| Rate for Payer: Ambetter Exchange |
$37.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.07
|
| Rate for Payer: Anthem Medicaid |
$37.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.17
|
| Rate for Payer: Cash Price |
$209.88
|
| Rate for Payer: Cash Price |
$209.88
|
| Rate for Payer: Cigna Commercial |
$76.29
|
| Rate for Payer: Healthspan PPO |
$73.98
|
| Rate for Payer: Humana Medicaid |
$37.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.48
|
| Rate for Payer: Molina Healthcare Passport |
$37.73
|
| Rate for Payer: Multiplan PHCS |
$251.85
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.93
|
| Rate for Payer: UHCCP Medicaid |
$21.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.64
|
|
|
LARYNGEAL FUNCTION STUDIES
|
Facility
|
OP
|
$419.75
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
76102452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$402.96 |
| Rate for Payer: Aetna Commercial |
$323.21
|
| Rate for Payer: Anthem Medicaid |
$144.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$209.88
|
| Rate for Payer: Cash Price |
$209.88
|
| Rate for Payer: Cigna Commercial |
$348.39
|
| Rate for Payer: First Health Commercial |
$398.76
|
| Rate for Payer: Humana Commercial |
$356.79
|
| Rate for Payer: Humana KY Medicaid |
$144.35
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$145.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.38
|
| Rate for Payer: Ohio Health Group HMO |
$314.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.63
|
| Rate for Payer: PHCS Commercial |
$402.96
|
| Rate for Payer: United Healthcare All Payer |
$369.38
|
|
|
LARYNGEAL FUNCTION STUDIES(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
761P2452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.07 |
| Max. Negotiated Rate |
$76.29 |
| Rate for Payer: Aetna Commercial |
$39.62
|
| Rate for Payer: Ambetter Exchange |
$37.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.07
|
| Rate for Payer: Anthem Medicaid |
$37.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.17
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$76.29
|
| Rate for Payer: Healthspan PPO |
$73.98
|
| Rate for Payer: Humana Medicaid |
$37.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.48
|
| Rate for Payer: Molina Healthcare Passport |
$37.73
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.93
|
| Rate for Payer: UHCCP Medicaid |
$21.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.64
|
|
|
LARYNGEAL FUNCTION STUDIES(T
|
Facility
|
IP
|
$319.75
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
761T2452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.92 |
| Max. Negotiated Rate |
$306.96 |
| Rate for Payer: Aetna Commercial |
$246.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.41
|
| Rate for Payer: Cash Price |
$159.88
|
| Rate for Payer: Cigna Commercial |
$265.39
|
| Rate for Payer: First Health Commercial |
$303.76
|
| Rate for Payer: Humana Commercial |
$271.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$262.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.38
|
| Rate for Payer: Ohio Health Group HMO |
$239.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.63
|
| Rate for Payer: PHCS Commercial |
$306.96
|
| Rate for Payer: United Healthcare All Payer |
$281.38
|
|
|
LARYNGEAL FUNCTION STUDIES(T
|
Facility
|
OP
|
$319.75
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
761T2452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$306.96 |
| Rate for Payer: Aetna Commercial |
$246.21
|
| Rate for Payer: Anthem Medicaid |
$109.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$159.88
|
| Rate for Payer: Cash Price |
$159.88
|
| Rate for Payer: Cigna Commercial |
$265.39
|
| Rate for Payer: First Health Commercial |
$303.76
|
| Rate for Payer: Humana Commercial |
$271.79
|
| Rate for Payer: Humana KY Medicaid |
$109.96
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$111.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$262.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.38
|
| Rate for Payer: Ohio Health Group HMO |
$239.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.63
|
| Rate for Payer: PHCS Commercial |
$306.96
|
| Rate for Payer: United Healthcare All Payer |
$281.38
|
|
|
LARYNGOSCOP FLEX AIRWAY
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
45000216
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$503.04 |
| Rate for Payer: Aetna Commercial |
$403.48
|
| Rate for Payer: Anthem Medicaid |
$180.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$179.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$408.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$251.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.16
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cigna Commercial |
$434.92
|
| Rate for Payer: First Health Commercial |
$497.80
|
| Rate for Payer: Humana Commercial |
$445.40
|
| Rate for Payer: Humana KY Medicaid |
$180.20
|
| Rate for Payer: Humana Medicare Advantage |
$179.38
|
| Rate for Payer: Kentucky WC Medicaid |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$429.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$386.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$183.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$461.12
|
| Rate for Payer: Ohio Health Group HMO |
$393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$419.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.56
|
| Rate for Payer: PHCS Commercial |
$503.04
|
| Rate for Payer: United Healthcare All Payer |
$461.12
|
|
|
LARYNGOSCOP FLEX AIRWAY
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
76101165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem Medicaid |
$300.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$179.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$251.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.16
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Humana KY Medicaid |
$300.57
|
| Rate for Payer: Humana Medicare Advantage |
$179.38
|
| Rate for Payer: Kentucky WC Medicaid |
$303.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$699.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.06
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
LARYNGOSCOP FLEX AIRWAY
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
76101165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.20 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$699.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.06
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
