|
EGD DIAGNOSTIC BRUSH WASH
|
Facility
|
OP
|
$3,155.05
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
76101736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$410.16 |
| Max. Negotiated Rate |
$3,028.85 |
| Rate for Payer: Aetna Commercial |
$2,429.39
|
| Rate for Payer: Anthem Medicaid |
$1,085.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,460.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$1,577.53
|
| Rate for Payer: Cash Price |
$1,577.53
|
| Rate for Payer: Cigna Commercial |
$2,618.69
|
| Rate for Payer: First Health Commercial |
$2,997.30
|
| Rate for Payer: Humana Commercial |
$2,681.79
|
| Rate for Payer: Humana KY Medicaid |
$1,085.02
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,096.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,587.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,328.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,106.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,776.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,366.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$631.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$978.07
|
| Rate for Payer: PHCS Commercial |
$3,028.85
|
| Rate for Payer: United Healthcare All Payer |
$2,776.44
|
|
|
EGD DIAGNOSTIC BRUSH WASH
|
Professional
|
Both
|
$3,155.05
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
76101736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.24 |
| Max. Negotiated Rate |
$3,155.05 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$124.24
|
| Rate for Payer: Anthem Medicaid |
$159.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,155.05
|
| Rate for Payer: Cash Price |
$1,577.53
|
| Rate for Payer: Cash Price |
$1,577.53
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: Healthspan PPO |
$360.67
|
| Rate for Payer: Humana Medicaid |
$159.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$190.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.71
|
| Rate for Payer: Molina Healthcare Passport |
$159.52
|
| Rate for Payer: Multiplan PHCS |
$1,893.03
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,208.54
|
| Rate for Payer: UHCCP Medicaid |
$130.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.12
|
|
|
EGD DIAGNOSTIC BRUSH WASH(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
761P1736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.24 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$124.24
|
| Rate for Payer: Anthem Medicaid |
$159.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: Healthspan PPO |
$360.67
|
| Rate for Payer: Humana Medicaid |
$159.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$190.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.71
|
| Rate for Payer: Molina Healthcare Passport |
$159.52
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$130.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.12
|
|
|
EGD DIAGNOSTIC BRUSH WASH(T
|
Facility
|
IP
|
$2,555.05
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
761T1736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.16 |
| Max. Negotiated Rate |
$2,452.85 |
| Rate for Payer: Aetna Commercial |
$1,967.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,992.94
|
| Rate for Payer: Cash Price |
$1,277.53
|
| Rate for Payer: Cigna Commercial |
$2,120.69
|
| Rate for Payer: First Health Commercial |
$2,427.30
|
| Rate for Payer: Humana Commercial |
$2,171.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,095.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,885.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$766.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,248.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,916.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$511.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$332.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$792.07
|
| Rate for Payer: PHCS Commercial |
$2,452.85
|
| Rate for Payer: United Healthcare All Payer |
$2,248.44
|
|
|
EGD DIAGNOSTIC BRUSH WASH(T
|
Facility
|
OP
|
$2,555.05
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
761T1736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.16 |
| Max. Negotiated Rate |
$2,452.85 |
| Rate for Payer: Aetna Commercial |
$1,967.39
|
| Rate for Payer: Anthem Medicaid |
$878.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,992.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$1,277.53
|
| Rate for Payer: Cash Price |
$1,277.53
|
| Rate for Payer: Cigna Commercial |
$2,120.69
|
| Rate for Payer: First Health Commercial |
$2,427.30
|
| Rate for Payer: Humana Commercial |
$2,171.79
|
| Rate for Payer: Humana KY Medicaid |
$878.68
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$887.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,095.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,885.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$896.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,248.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,916.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$511.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$332.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$792.07
|
| Rate for Payer: PHCS Commercial |
$2,452.85
|
| Rate for Payer: United Healthcare All Payer |
$2,248.44
|
|
|
EGD DILATE STRICTURE
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
HCPCS 43245
|
| Hospital Charge Code |
76101741
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.70 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$685.30
|
| Rate for Payer: Anthem Medicaid |
$306.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$738.70
|
| Rate for Payer: First Health Commercial |
$845.50
|
| Rate for Payer: Humana Commercial |
$756.50
|
| Rate for Payer: Humana KY Medicaid |
$306.07
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$309.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$729.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$656.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$312.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$783.20
|
| Rate for Payer: Ohio Health Group HMO |
$667.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$178.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$275.90
|
| Rate for Payer: PHCS Commercial |
$854.40
|
| Rate for Payer: United Healthcare All Payer |
$783.20
|
|
|
EGD DILATE STRICTURE
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
HCPCS 43245
|
| Hospital Charge Code |
76101741
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.70 |
| Max. Negotiated Rate |
$854.40 |
| Rate for Payer: Aetna Commercial |
$685.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.20
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$738.70
|
| Rate for Payer: First Health Commercial |
$845.50
|
| Rate for Payer: Humana Commercial |
$756.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$729.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$656.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$267.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$783.20
|
| Rate for Payer: Ohio Health Group HMO |
$667.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$178.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$275.90
|
| Rate for Payer: PHCS Commercial |
$854.40
|
| Rate for Payer: United Healthcare All Payer |
$783.20
|
|
|
EGD DILATE STRICTURE
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 43245
|
| Hospital Charge Code |
76101741
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.87 |
| Max. Negotiated Rate |
$890.00 |
| Rate for Payer: Aetna Commercial |
$286.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.87
|
| Rate for Payer: Anthem Medicaid |
$225.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$890.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$260.23
|
| Rate for Payer: Healthspan PPO |
$241.74
|
| Rate for Payer: Humana Medicaid |
$225.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$246.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$230.11
|
| Rate for Payer: Molina Healthcare Passport |
$225.60
|
| Rate for Payer: Multiplan PHCS |
$534.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$623.00
|
| Rate for Payer: UHCCP Medicaid |
$145.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.86
|
|
|
EGD DILATE STRICTURE(P
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 43245
|
| Hospital Charge Code |
761P1741
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.87 |
| Max. Negotiated Rate |
$890.00 |
| Rate for Payer: Aetna Commercial |
$286.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.87
|
| Rate for Payer: Anthem Medicaid |
$225.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$890.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$260.23
|
| Rate for Payer: Healthspan PPO |
$241.74
|
| Rate for Payer: Humana Medicaid |
$225.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$246.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$230.11
|
| Rate for Payer: Molina Healthcare Passport |
$225.60
|
| Rate for Payer: Multiplan PHCS |
$534.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$623.00
|
| Rate for Payer: UHCCP Medicaid |
$145.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.86
|
|
|
EGD ENDO MUCOSAL RESECTION
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 43254
|
| Hospital Charge Code |
76101748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Anthem Medicaid |
$226.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$630.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$466.60
|
| Rate for Payer: Healthspan PPO |
$387.29
|
| Rate for Payer: Humana Medicaid |
$226.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$366.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.08
|
| Rate for Payer: Molina Healthcare Passport |
$226.55
|
| Rate for Payer: Multiplan PHCS |
$378.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.00
|
| Rate for Payer: UHCCP Medicaid |
$220.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$228.82
|
|
|
EGD ENDO MUCOSAL RESECTION
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS 43254
|
| Hospital Charge Code |
76101748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$491.40
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$522.90
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Humana Commercial |
$535.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$516.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$554.40
|
| Rate for Payer: Ohio Health Group HMO |
$472.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.30
|
| Rate for Payer: PHCS Commercial |
$604.80
|
| Rate for Payer: United Healthcare All Payer |
$554.40
|
|
|
EGD ENDO MUCOSAL RESECTION
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS 43254
|
| Hospital Charge Code |
76101748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Anthem Medicaid |
$216.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$491.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$522.90
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Humana Commercial |
$535.50
|
| Rate for Payer: Humana KY Medicaid |
$216.66
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$218.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$516.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$554.40
|
| Rate for Payer: Ohio Health Group HMO |
$472.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.30
|
| Rate for Payer: PHCS Commercial |
$604.80
|
| Rate for Payer: United Healthcare All Payer |
$554.40
|
|
|
EGD ENDO MUCOSAL RESECTION(P
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 43254
|
| Hospital Charge Code |
761P1748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Anthem Medicaid |
$226.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$630.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$466.60
|
| Rate for Payer: Healthspan PPO |
$387.29
|
| Rate for Payer: Humana Medicaid |
$226.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$366.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.08
|
| Rate for Payer: Molina Healthcare Passport |
$226.55
|
| Rate for Payer: Multiplan PHCS |
$378.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.00
|
| Rate for Payer: UHCCP Medicaid |
$220.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$228.82
|
|
|
EGD ENDOSCOPIC STENT PLACE
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 43266
|
| Hospital Charge Code |
76101756
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$6,899.82 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,928.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,899.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,653.39
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Humana KY Medicaid |
$163.35
|
| Rate for Payer: Humana Medicare Advantage |
$4,928.44
|
| Rate for Payer: Kentucky WC Medicaid |
$165.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,914.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
EGD ENDOSCOPIC STENT PLACE
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 43266
|
| Hospital Charge Code |
76101756
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
EGD ENDOSCOPIC STENT PLACE
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 43266
|
| Hospital Charge Code |
76101756
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Anthem Medicaid |
$187.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$386.21
|
| Rate for Payer: Healthspan PPO |
$320.67
|
| Rate for Payer: Humana Medicaid |
$187.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$303.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$191.25
|
| Rate for Payer: Molina Healthcare Passport |
$187.50
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$166.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$189.38
|
|
|
EGD ENDOSCOPIC STENT PLACE(P
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 43266
|
| Hospital Charge Code |
761P1756
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Anthem Medicaid |
$187.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$386.21
|
| Rate for Payer: Healthspan PPO |
$320.67
|
| Rate for Payer: Humana Medicaid |
$187.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$303.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$191.25
|
| Rate for Payer: Molina Healthcare Passport |
$187.50
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$166.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$189.38
|
|
|
EGD ESOPHAGOGASTRC FNDOPLST(P
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 43210
|
| Hospital Charge Code |
761P1729
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$713.55 |
| Rate for Payer: Anthem Medicaid |
$348.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$645.00
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$713.55
|
| Rate for Payer: Humana Medicaid |
$348.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$601.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$355.69
|
| Rate for Payer: Molina Healthcare Passport |
$348.72
|
| Rate for Payer: Multiplan PHCS |
$387.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$451.50
|
| Rate for Payer: UHCCP Medicaid |
$225.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$352.21
|
|
|
EGD ESOPHAGOGASTRC FNDOPLSTY
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
HCPCS 43210
|
| Hospital Charge Code |
76101729
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$619.20 |
| Rate for Payer: Aetna Commercial |
$496.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$503.10
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$535.35
|
| Rate for Payer: First Health Commercial |
$612.75
|
| Rate for Payer: Humana Commercial |
$548.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$528.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$476.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$567.60
|
| Rate for Payer: Ohio Health Group HMO |
$483.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$199.95
|
| Rate for Payer: PHCS Commercial |
$619.20
|
| Rate for Payer: United Healthcare All Payer |
$567.60
|
|
|
EGD ESOPHAGOGASTRC FNDOPLSTY
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 43210
|
| Hospital Charge Code |
76101729
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$713.55 |
| Rate for Payer: Anthem Medicaid |
$348.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$645.00
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$713.55
|
| Rate for Payer: Humana Medicaid |
$348.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$601.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$355.69
|
| Rate for Payer: Molina Healthcare Passport |
$348.72
|
| Rate for Payer: Multiplan PHCS |
$387.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$451.50
|
| Rate for Payer: UHCCP Medicaid |
$225.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$352.21
|
|
|
EGD ESOPHAGOGASTRC FNDOPLSTY
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 43210
|
| Hospital Charge Code |
76101729
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$12,462.13 |
| Rate for Payer: Aetna Commercial |
$496.65
|
| Rate for Payer: Anthem Medicaid |
$221.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,901.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$503.10
|
| 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 |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$535.35
|
| Rate for Payer: First Health Commercial |
$612.75
|
| Rate for Payer: Humana Commercial |
$548.25
|
| Rate for Payer: Humana KY Medicaid |
$221.82
|
| Rate for Payer: Humana Medicare Advantage |
$8,901.52
|
| Rate for Payer: Kentucky WC Medicaid |
$224.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$528.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$476.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,681.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$226.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$567.60
|
| Rate for Payer: Ohio Health Group HMO |
$483.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$199.95
|
| Rate for Payer: PHCS Commercial |
$619.20
|
| Rate for Payer: United Healthcare All Payer |
$567.60
|
|
|
EGD EXC TUMOR - POLYP
|
Facility
|
IP
|
$2,881.00
|
|
|
Service Code
|
HCPCS 43216
|
| Hospital Charge Code |
76101731
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.53 |
| Max. Negotiated Rate |
$2,765.76 |
| Rate for Payer: Aetna Commercial |
$2,218.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,247.18
|
| Rate for Payer: Cash Price |
$1,440.50
|
| Rate for Payer: Cigna Commercial |
$2,391.23
|
| Rate for Payer: First Health Commercial |
$2,736.95
|
| Rate for Payer: Humana Commercial |
$2,448.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,362.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,126.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$864.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,535.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,160.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$576.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$893.11
|
| Rate for Payer: PHCS Commercial |
$2,765.76
|
| Rate for Payer: United Healthcare All Payer |
$2,535.28
|
|
|
EGD EXC TUMOR - POLYP
|
Facility
|
OP
|
$2,881.00
|
|
|
Service Code
|
HCPCS 43216
|
| Hospital Charge Code |
76101731
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.53 |
| Max. Negotiated Rate |
$2,765.76 |
| Rate for Payer: Aetna Commercial |
$2,218.37
|
| Rate for Payer: Anthem Medicaid |
$990.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,247.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$1,440.50
|
| Rate for Payer: Cash Price |
$1,440.50
|
| Rate for Payer: Cigna Commercial |
$2,391.23
|
| Rate for Payer: First Health Commercial |
$2,736.95
|
| Rate for Payer: Humana Commercial |
$2,448.85
|
| Rate for Payer: Humana KY Medicaid |
$990.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,000.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,362.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,126.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,010.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,535.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,160.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$576.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$893.11
|
| Rate for Payer: PHCS Commercial |
$2,765.76
|
| Rate for Payer: United Healthcare All Payer |
$2,535.28
|
|
|
EGD EXC TUMOR - POLYP
|
Professional
|
Both
|
$2,881.00
|
|
|
Service Code
|
HCPCS 43216
|
| Hospital Charge Code |
76101731
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.07 |
| Max. Negotiated Rate |
$2,881.00 |
| Rate for Payer: Aetna Commercial |
$218.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$128.07
|
| Rate for Payer: Anthem Medicaid |
$175.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,881.00
|
| Rate for Payer: Cash Price |
$1,440.50
|
| Rate for Payer: Cash Price |
$1,440.50
|
| Rate for Payer: Cigna Commercial |
$199.52
|
| Rate for Payer: Healthspan PPO |
$243.04
|
| Rate for Payer: Humana Medicaid |
$175.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.95
|
| Rate for Payer: Molina Healthcare Passport |
$175.44
|
| Rate for Payer: Multiplan PHCS |
$1,728.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,016.70
|
| Rate for Payer: UHCCP Medicaid |
$134.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.19
|
|
|
EGD EXC TUMOR - POLYP(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 43216
|
| Hospital Charge Code |
761P1731
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.07 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$218.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$128.07
|
| Rate for Payer: Anthem Medicaid |
$175.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$199.52
|
| Rate for Payer: Healthspan PPO |
$243.04
|
| Rate for Payer: Humana Medicaid |
$175.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.95
|
| Rate for Payer: Molina Healthcare Passport |
$175.44
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$134.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.19
|
|
