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 |
$440.00 |
Rate for Payer: Aetna Commercial |
$286.90
|
Rate for Payer: Anthem Medicaid |
$146.37
|
Rate for Payer: Buckeye Medicare Advantage |
$440.00
|
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: 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 |
$308.00
|
Rate for Payer: UHCCP Medicaid |
$154.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$147.83
|
|
LAP MYOTOMY HELLER
|
Facility
|
IP
|
$1,515.00
|
|
Service Code
|
HCPCS 43279
|
Hospital Charge Code |
76101763
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$196.95 |
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 |
$303.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$196.95
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.65
|
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: Anthem Medicaid |
$969.91
|
Rate for Payer: Buckeye Medicare Advantage |
$1,515.00
|
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: 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 |
$1,060.50
|
Rate for Payer: UHCCP Medicaid |
$530.25
|
Rate for Payer: Wellcare CHIP/Medicaid |
$979.61
|
|
LAP MYOTOMY HELLER
|
Facility
|
OP
|
$1,515.00
|
|
Service Code
|
HCPCS 43279
|
Hospital Charge Code |
76101763
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$196.95 |
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 |
$303.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$196.95
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.65
|
Rate for Payer: PHCS Commercial |
$1,454.40
|
Rate for Payer: United Healthcare All Payer |
$1,333.20
|
|
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: Anthem Medicaid |
$969.91
|
Rate for Payer: Buckeye Medicare Advantage |
$1,515.00
|
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: 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 |
$1,060.50
|
Rate for Payer: UHCCP Medicaid |
$530.25
|
Rate for Payer: Wellcare CHIP/Medicaid |
$979.61
|
|
LAP PARAESOPHAG HERN REPAIR
|
Professional
|
Both
|
$3,300.00
|
|
Service Code
|
HCPCS 43281
|
Hospital Charge Code |
76101765
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$1,149.87 |
Max. Negotiated Rate |
$3,300.00 |
Rate for Payer: Aetna Commercial |
$2,457.48
|
Rate for Payer: Anthem Medicaid |
$1,149.87
|
Rate for Payer: Buckeye Medicare Advantage |
$3,300.00
|
Rate for Payer: Cash Price |
$1,650.00
|
Rate for Payer: Cash Price |
$1,650.00
|
Rate for Payer: Cigna Commercial |
$2,462.79
|
Rate for Payer: Healthspan PPO |
$1,632.38
|
Rate for Payer: Humana Medicaid |
$1,149.87
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,042.93
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,172.87
|
Rate for Payer: Molina Healthcare Passport |
$1,149.87
|
Rate for Payer: Multiplan PHCS |
$1,980.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,310.00
|
Rate for Payer: UHCCP Medicaid |
$1,155.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$1,161.37
|
|
LAP PARAESOPHAG HERN REPAIR
|
Facility
|
IP
|
$3,300.00
|
|
Service Code
|
HCPCS 43281
|
Hospital Charge Code |
76101765
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$429.00 |
Max. Negotiated Rate |
$3,168.00 |
Rate for Payer: Aetna Commercial |
$2,541.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
Rate for Payer: Cash Price |
$1,650.00
|
Rate for Payer: Cigna Commercial |
$2,739.00
|
Rate for Payer: First Health Commercial |
$3,135.00
|
Rate for Payer: Humana Commercial |
$2,805.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$990.00
|
Rate for Payer: Ohio Health Choice Commercial |
$2,904.00
|
Rate for Payer: Ohio Health Group HMO |
$2,475.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$429.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.00
|
Rate for Payer: PHCS Commercial |
$3,168.00
|
Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
LAP PARAESOPHAG HERN REPAIR
|
Facility
|
OP
|
$3,300.00
|
|
Service Code
|
HCPCS 43281
|
Hospital Charge Code |
76101765
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$429.00 |
Max. Negotiated Rate |
$12,462.13 |
Rate for Payer: Aetna Commercial |
$2,541.00
|
Rate for Payer: Anthem Medicaid |
$1,134.87
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$8,901.52
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,462.13
|
Rate for Payer: CareSource Just4Me Medicare |
$12,017.05
|
Rate for Payer: Cash Price |
$1,650.00
|
Rate for Payer: Cash Price |
$1,650.00
|
Rate for Payer: Cigna Commercial |
$2,739.00
|
Rate for Payer: First Health Commercial |
$3,135.00
|
Rate for Payer: Humana Commercial |
$2,805.00
|
Rate for Payer: Humana KY Medicaid |
$1,134.87
|
Rate for Payer: Humana Medicare Advantage |
$8,901.52
|
Rate for Payer: Kentucky WC Medicaid |
$1,146.42
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$10,681.82
|
Rate for Payer: Molina Healthcare Medicaid |
$1,157.64
|
Rate for Payer: Ohio Health Choice Commercial |
$2,904.00
|
Rate for Payer: Ohio Health Group HMO |
$2,475.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$429.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.00
|
Rate for Payer: PHCS Commercial |
$3,168.00
|
Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
LAP PARAESOPHAG HERN REPAIR(P
|
Professional
|
Both
|
$3,300.00
|
|
Service Code
|
HCPCS 43281
|
Hospital Charge Code |
761P1765
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$1,149.87 |
Max. Negotiated Rate |
$3,300.00 |
Rate for Payer: Aetna Commercial |
$2,457.48
|
Rate for Payer: Anthem Medicaid |
$1,149.87
|
Rate for Payer: Buckeye Medicare Advantage |
$3,300.00
|
Rate for Payer: Cash Price |
$1,650.00
|
Rate for Payer: Cash Price |
$1,650.00
|
Rate for Payer: Cigna Commercial |
$2,462.79
|
Rate for Payer: Healthspan PPO |
$1,632.38
|
Rate for Payer: Humana Medicaid |
$1,149.87
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,042.93
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,172.87
|
Rate for Payer: Molina Healthcare Passport |
$1,149.87
|
Rate for Payer: Multiplan PHCS |
$1,980.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,310.00
|
Rate for Payer: UHCCP Medicaid |
$1,155.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$1,161.37
|
|
LAP PARAESOPH HER RPR W/MESH
|
Professional
|
Both
|
$2,400.00
|
|
Service Code
|
HCPCS 43282
|
Hospital Charge Code |
76101766
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$840.00 |
Max. Negotiated Rate |
$2,770.60 |
Rate for Payer: Aetna Commercial |
$2,765.05
|
Rate for Payer: Anthem Medicaid |
$1,293.66
|
Rate for Payer: Buckeye Medicare Advantage |
$2,400.00
|
Rate for Payer: Cash Price |
$1,200.00
|
Rate for Payer: Cash Price |
$1,200.00
|
Rate for Payer: Cigna Commercial |
$2,770.60
|
Rate for Payer: Healthspan PPO |
$1,836.90
|
Rate for Payer: Humana Medicaid |
$1,293.66
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,296.03
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,319.53
|
Rate for Payer: Molina Healthcare Passport |
$1,293.66
|
Rate for Payer: Multiplan PHCS |
$1,440.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,680.00
|
Rate for Payer: UHCCP Medicaid |
$840.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$1,306.60
|
|
LAP PARAESOPH HER RPR W/MESH
|
Facility
|
OP
|
$2,400.00
|
|
Service Code
|
HCPCS 43282
|
Hospital Charge Code |
76101766
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$312.00 |
Max. Negotiated Rate |
$12,462.13 |
Rate for Payer: Aetna Commercial |
$1,848.00
|
Rate for Payer: Anthem Medicaid |
$825.36
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$8,901.52
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,462.13
|
Rate for Payer: CareSource Just4Me Medicare |
$12,017.05
|
Rate for Payer: Cash Price |
$1,200.00
|
Rate for Payer: Cash Price |
$1,200.00
|
Rate for Payer: Cigna Commercial |
$1,992.00
|
Rate for Payer: First Health Commercial |
$2,280.00
|
Rate for Payer: Humana Commercial |
$2,040.00
|
Rate for Payer: Humana KY Medicaid |
$825.36
|
Rate for Payer: Humana Medicare Advantage |
$8,901.52
|
Rate for Payer: Kentucky WC Medicaid |
$833.76
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$10,681.82
|
Rate for Payer: Molina Healthcare Medicaid |
$841.92
|
Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$312.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.00
|
Rate for Payer: PHCS Commercial |
$2,304.00
|
Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
LAP PARAESOPH HER RPR W/MESH
|
Facility
|
IP
|
$2,400.00
|
|
Service Code
|
HCPCS 43282
|
Hospital Charge Code |
76101766
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$312.00 |
Max. Negotiated Rate |
$2,304.00 |
Rate for Payer: Aetna Commercial |
$1,848.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
Rate for Payer: Cash Price |
$1,200.00
|
Rate for Payer: Cigna Commercial |
$1,992.00
|
Rate for Payer: First Health Commercial |
$2,280.00
|
Rate for Payer: Humana Commercial |
$2,040.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$312.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.00
|
Rate for Payer: PHCS Commercial |
$2,304.00
|
Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
LAP PARAESOPH HER RPR W/MES(P
|
Professional
|
Both
|
$2,400.00
|
|
Service Code
|
HCPCS 43282
|
Hospital Charge Code |
761P1766
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$840.00 |
Max. Negotiated Rate |
$2,770.60 |
Rate for Payer: Aetna Commercial |
$2,765.05
|
Rate for Payer: Anthem Medicaid |
$1,293.66
|
Rate for Payer: Buckeye Medicare Advantage |
$2,400.00
|
Rate for Payer: Cash Price |
$1,200.00
|
Rate for Payer: Cash Price |
$1,200.00
|
Rate for Payer: Cigna Commercial |
$2,770.60
|
Rate for Payer: Healthspan PPO |
$1,836.90
|
Rate for Payer: Humana Medicaid |
$1,293.66
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,296.03
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,319.53
|
Rate for Payer: Molina Healthcare Passport |
$1,293.66
|
Rate for Payer: Multiplan PHCS |
$1,440.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,680.00
|
Rate for Payer: UHCCP Medicaid |
$840.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$1,306.60
|
|
LAP REDUC INT HERNIA
|
Professional
|
Both
|
$1,155.00
|
|
Service Code
|
HCPCS 44238
|
Hospital Charge Code |
76102687
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$0.60 |
Max. Negotiated Rate |
$2,527.03 |
Rate for Payer: Buckeye Medicare Advantage |
$1,155.00
|
Rate for Payer: Cash Price |
$577.50
|
Rate for Payer: Cash Price |
$577.50
|
Rate for Payer: Healthspan PPO |
$0.60
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,527.03
|
Rate for Payer: Multiplan PHCS |
$693.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$808.50
|
Rate for Payer: UHCCP Medicaid |
$404.25
|
|
LAP REPR RECUR ING HERNIA
|
Facility
|
IP
|
$1,300.00
|
|
Service Code
|
HCPCS 49651
|
Hospital Charge Code |
76102033
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$169.00 |
Max. Negotiated Rate |
$1,248.00 |
Rate for Payer: Aetna Commercial |
$1,001.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cigna Commercial |
$1,079.00
|
Rate for Payer: First Health Commercial |
$1,235.00
|
Rate for Payer: Humana Commercial |
$1,105.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
Rate for Payer: Ohio Health Group HMO |
$975.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
Rate for Payer: PHCS Commercial |
$1,248.00
|
Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
LAP REPR RECUR ING HERNIA
|
Facility
|
OP
|
$1,300.00
|
|
Service Code
|
HCPCS 49651
|
Hospital Charge Code |
76102033
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$169.00 |
Max. Negotiated Rate |
$6,985.45 |
Rate for Payer: Aetna Commercial |
$1,001.00
|
Rate for Payer: Anthem Medicaid |
$447.07
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cigna Commercial |
$1,079.00
|
Rate for Payer: First Health Commercial |
$1,235.00
|
Rate for Payer: Humana Commercial |
$1,105.00
|
Rate for Payer: Humana KY Medicaid |
$447.07
|
Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
Rate for Payer: Kentucky WC Medicaid |
$451.62
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
Rate for Payer: Ohio Health Group HMO |
$975.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
Rate for Payer: PHCS Commercial |
$1,248.00
|
Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
LAP REPR RECUR ING HERNIA
|
Professional
|
Both
|
$1,300.00
|
|
Service Code
|
HCPCS 49651
|
Hospital Charge Code |
76102033
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$387.99 |
Max. Negotiated Rate |
$1,300.00 |
Rate for Payer: Aetna Commercial |
$787.19
|
Rate for Payer: Anthem Medicaid |
$387.99
|
Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cigna Commercial |
$730.58
|
Rate for Payer: Healthspan PPO |
$663.85
|
Rate for Payer: Humana Medicaid |
$387.99
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$699.60
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$395.75
|
Rate for Payer: Molina Healthcare Passport |
$387.99
|
Rate for Payer: Multiplan PHCS |
$780.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
Rate for Payer: UHCCP Medicaid |
$455.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$391.87
|
|
LAP REPR RECUR ING HERNIA(P
|
Professional
|
Both
|
$1,300.00
|
|
Service Code
|
HCPCS 49651
|
Hospital Charge Code |
761P2033
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$387.99 |
Max. Negotiated Rate |
$1,300.00 |
Rate for Payer: Aetna Commercial |
$787.19
|
Rate for Payer: Anthem Medicaid |
$387.99
|
Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cigna Commercial |
$730.58
|
Rate for Payer: Healthspan PPO |
$663.85
|
Rate for Payer: Humana Medicaid |
$387.99
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$699.60
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$395.75
|
Rate for Payer: Molina Healthcare Passport |
$387.99
|
Rate for Payer: Multiplan PHCS |
$780.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
Rate for Payer: UHCCP Medicaid |
$455.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$391.87
|
|
LAP RESEC GI TUMOR STOMACH
|
Professional
|
Both
|
$1,023.36
|
|
Service Code
|
HCPCS 43659
|
Hospital Charge Code |
76102732
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$0.60 |
Max. Negotiated Rate |
$1,023.36 |
Rate for Payer: Buckeye Medicare Advantage |
$1,023.36
|
Rate for Payer: Cash Price |
$511.68
|
Rate for Payer: Cash Price |
$511.68
|
Rate for Payer: Healthspan PPO |
$0.60
|
Rate for Payer: Multiplan PHCS |
$614.02
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$716.35
|
Rate for Payer: UHCCP Medicaid |
$358.18
|
|
LAP RESECT S/INTESTINE ADDL
|
Professional
|
Both
|
$554.00
|
|
Service Code
|
HCPCS 44203
|
Hospital Charge Code |
51000298
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$180.61 |
Max. Negotiated Rate |
$554.00 |
Rate for Payer: Aetna Commercial |
$364.33
|
Rate for Payer: Anthem Medicaid |
$180.61
|
Rate for Payer: Buckeye Medicare Advantage |
$554.00
|
Rate for Payer: Cash Price |
$277.00
|
Rate for Payer: Cash Price |
$277.00
|
Rate for Payer: Cigna Commercial |
$345.63
|
Rate for Payer: Healthspan PPO |
$307.25
|
Rate for Payer: Humana Medicaid |
$180.61
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$314.22
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.22
|
Rate for Payer: Molina Healthcare Passport |
$180.61
|
Rate for Payer: Multiplan PHCS |
$332.40
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$387.80
|
Rate for Payer: UHCCP Medicaid |
$193.90
|
Rate for Payer: Wellcare CHIP/Medicaid |
$182.42
|
|
LAP REVISE GASTR ADJ DEVICE
|
Facility
|
IP
|
$1,600.00
|
|
Service Code
|
HCPCS 43771
|
Hospital Charge Code |
76101794
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$208.00 |
Max. Negotiated Rate |
$1,536.00 |
Rate for Payer: Aetna Commercial |
$1,232.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
Rate for Payer: Cash Price |
$800.00
|
Rate for Payer: Cigna Commercial |
$1,328.00
|
Rate for Payer: First Health Commercial |
$1,520.00
|
Rate for Payer: Humana Commercial |
$1,360.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
Rate for Payer: PHCS Commercial |
$1,536.00
|
Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
LAP REVISE GASTR ADJ DEVICE
|
Professional
|
Both
|
$1,600.00
|
|
Service Code
|
HCPCS 43771
|
Hospital Charge Code |
76101794
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$560.00 |
Max. Negotiated Rate |
$1,826.92 |
Rate for Payer: Aetna Commercial |
$1,826.92
|
Rate for Payer: Anthem Medicaid |
$864.05
|
Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
Rate for Payer: Cash Price |
$800.00
|
Rate for Payer: Cash Price |
$800.00
|
Rate for Payer: Cigna Commercial |
$1,707.92
|
Rate for Payer: Healthspan PPO |
$1,540.67
|
Rate for Payer: Humana Medicaid |
$864.05
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,620.89
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$881.33
|
Rate for Payer: Molina Healthcare Passport |
$864.05
|
Rate for Payer: Multiplan PHCS |
$960.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
Rate for Payer: UHCCP Medicaid |
$560.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$872.69
|
|
LAP REVISE GASTR ADJ DEVICE
|
Facility
|
OP
|
$1,600.00
|
|
Service Code
|
HCPCS 43771
|
Hospital Charge Code |
76101794
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$208.00 |
Max. Negotiated Rate |
$1,536.00 |
Rate for Payer: Aetna Commercial |
$1,232.00
|
Rate for Payer: Anthem Medicaid |
$550.24
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
Rate for Payer: Cash Price |
$800.00
|
Rate for Payer: Cigna Commercial |
$1,328.00
|
Rate for Payer: First Health Commercial |
$1,520.00
|
Rate for Payer: Humana Commercial |
$1,360.00
|
Rate for Payer: Humana KY Medicaid |
$550.24
|
Rate for Payer: Kentucky WC Medicaid |
$555.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
Rate for Payer: PHCS Commercial |
$1,536.00
|
Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
LAP REVISE GASTR ADJ DEVICE(P
|
Professional
|
Both
|
$1,600.00
|
|
Service Code
|
HCPCS 43771
|
Hospital Charge Code |
761P1794
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$560.00 |
Max. Negotiated Rate |
$1,826.92 |
Rate for Payer: Aetna Commercial |
$1,826.92
|
Rate for Payer: Anthem Medicaid |
$864.05
|
Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
Rate for Payer: Cash Price |
$800.00
|
Rate for Payer: Cash Price |
$800.00
|
Rate for Payer: Cigna Commercial |
$1,707.92
|
Rate for Payer: Healthspan PPO |
$1,540.67
|
Rate for Payer: Humana Medicaid |
$864.05
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,620.89
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$881.33
|
Rate for Payer: Molina Healthcare Passport |
$864.05
|
Rate for Payer: Multiplan PHCS |
$960.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
Rate for Payer: UHCCP Medicaid |
$560.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$872.69
|
|
LAPS PX SPRMATIC CORD
|
Professional
|
Both
|
$1,000.00
|
|
Service Code
|
HCPCS 55559
|
Hospital Charge Code |
76102898
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$0.60 |
Max. Negotiated Rate |
$1,000.00 |
Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
Rate for Payer: Cash Price |
$500.00
|
Rate for Payer: Cash Price |
$500.00
|
Rate for Payer: Healthspan PPO |
$0.60
|
Rate for Payer: Multiplan PHCS |
$600.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
Rate for Payer: UHCCP Medicaid |
$350.00
|
|