|
LAP OVERSEW PATCH GASTROESOPHA
|
Professional
|
Both
|
$6,065.00
|
|
|
Service Code
|
HCPCS 43289
|
| Hospital Charge Code |
76103037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4,245.50 |
| Rate for Payer: Cash Price |
$3,032.50
|
| Rate for Payer: Cash Price |
$3,032.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$3,639.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,245.50
|
| Rate for Payer: UHCCP Medicaid |
$2,122.75
|
|
|
LAP PARAESOPHAG HERN REPAIR
|
Facility
|
OP
|
$3,300.00
|
|
|
Service Code
|
HCPCS 43281
|
| Hospital Charge Code |
76101765
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,134.87 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$2,541.00
|
| Rate for Payer: Anthem Medicaid |
$1,134.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
| 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 |
$1,650.00
|
| 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 |
$9,619.76
|
| 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 |
$11,543.71
|
| 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 |
$2,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,871.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,277.00
|
| Rate for Payer: PHCS Commercial |
$3,168.00
|
| Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
|
LAP PARAESOPHAG HERN REPAIR
|
Facility
|
IP
|
$3,300.00
|
|
|
Service Code
|
HCPCS 43281
|
| Hospital Charge Code |
76101765
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$990.00 |
| 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 |
$2,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,871.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,277.00
|
| Rate for Payer: PHCS Commercial |
$3,168.00
|
| Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
|
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 |
$2,462.79 |
| Rate for Payer: Aetna Commercial |
$2,457.48
|
| Rate for Payer: Ambetter Exchange |
$1,461.24
|
| Rate for Payer: Anthem Medicaid |
$1,149.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,461.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,461.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,753.49
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,461.24
|
| 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 |
$1,899.61
|
| Rate for Payer: UHCCP Medicaid |
$1,155.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,161.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,461.24
|
|
|
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 |
$2,462.79 |
| Rate for Payer: Aetna Commercial |
$2,457.48
|
| Rate for Payer: Ambetter Exchange |
$1,461.24
|
| Rate for Payer: Anthem Medicaid |
$1,149.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,461.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,461.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,753.49
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,461.24
|
| 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 |
$1,899.61
|
| Rate for Payer: UHCCP Medicaid |
$1,155.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,161.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,461.24
|
|
|
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 |
$825.36 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem Medicaid |
$825.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| 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 |
$1,200.00
|
| 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 |
$9,619.76
|
| 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 |
$11,543.71
|
| 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 |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
LAP PARAESOPH HER RPR W/MESH
|
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: Ambetter Exchange |
$1,647.51
|
| Rate for Payer: Anthem Medicaid |
$1,293.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,647.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,647.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,977.01
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,647.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.51
|
| 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 |
$2,141.76
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,306.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,647.51
|
|
|
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 |
$720.00 |
| 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 |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| 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: Ambetter Exchange |
$1,647.51
|
| Rate for Payer: Anthem Medicaid |
$1,293.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,647.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,647.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,977.01
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,647.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.51
|
| 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 |
$2,141.76
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,306.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,647.51
|
|
|
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: 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 REPAIR DIAPHRAGM HERNIA
|
Facility
|
OP
|
$2,075.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
76102951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$713.59 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,597.75
|
| Rate for Payer: Anthem Medicaid |
$713.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.50
|
| 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 |
$1,037.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,722.25
|
| Rate for Payer: First Health Commercial |
$1,971.25
|
| Rate for Payer: Humana Commercial |
$1,763.75
|
| Rate for Payer: Humana KY Medicaid |
$713.59
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$720.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,805.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.75
|
| Rate for Payer: PHCS Commercial |
$1,992.00
|
| Rate for Payer: United Healthcare All Payer |
$1,826.00
|
|
|
LAP REPAIR DIAPHRAGM HERNIA
|
Facility
|
IP
|
$2,075.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
76102951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$622.50 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Aetna Commercial |
$1,597.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,722.25
|
| Rate for Payer: First Health Commercial |
$1,971.25
|
| Rate for Payer: Humana Commercial |
$1,763.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,805.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.75
|
| Rate for Payer: PHCS Commercial |
$1,992.00
|
| Rate for Payer: United Healthcare All Payer |
$1,826.00
|
|
|
LAP REPAIR DIAPHRAGM HERNIA
|
Professional
|
Both
|
$2,075.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
76102951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,452.50 |
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,245.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,452.50
|
| Rate for Payer: UHCCP Medicaid |
$726.25
|
|
|
LAP REP BI FEMORAL HERNIAS
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
76102985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
|
|
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 |
$447.07 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| 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 |
$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 |
$5,390.83
|
| 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 |
$6,469.00
|
| 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 |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| 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 |
$787.19 |
| Rate for Payer: Aetna Commercial |
$787.19
|
| Rate for Payer: Ambetter Exchange |
$540.51
|
| Rate for Payer: Anthem Medicaid |
$387.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$540.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$540.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$648.61
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$540.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.51
|
| 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 |
$702.66
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$391.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$540.51
|
|
|
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 |
$390.00 |
| 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 |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
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 |
$787.19 |
| Rate for Payer: Aetna Commercial |
$787.19
|
| Rate for Payer: Ambetter Exchange |
$540.51
|
| Rate for Payer: Anthem Medicaid |
$387.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$540.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$540.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$648.61
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$540.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.51
|
| 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 |
$702.66
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$391.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$540.51
|
|
|
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 |
$716.35 |
| 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 |
$364.33 |
| Rate for Payer: Aetna Commercial |
$364.33
|
| Rate for Payer: Ambetter Exchange |
$227.54
|
| Rate for Payer: Anthem Medicaid |
$180.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$227.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$227.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$273.05
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$227.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.54
|
| 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 |
$295.80
|
| Rate for Payer: UHCCP Medicaid |
$193.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$227.54
|
|
|
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 |
$480.00 |
| 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 |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
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 |
$480.00 |
| 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 |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| 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: Ambetter Exchange |
$1,219.10
|
| Rate for Payer: Anthem Medicaid |
$864.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,219.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,219.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,462.92
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,219.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.10
|
| 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 |
$1,584.83
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$872.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,219.10
|
|
|
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: Ambetter Exchange |
$1,219.10
|
| Rate for Payer: Anthem Medicaid |
$864.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,219.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,219.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,462.92
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,219.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.10
|
| 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 |
$1,584.83
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$872.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,219.10
|
|
|
LAPRSPIC GASTRO & REM PEG
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 43659
|
| Hospital Charge Code |
76103023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
|
