|
EGD EXC TUMOR - POLYP(T
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
HCPCS 43216
|
| Hospital Charge Code |
761T1731
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.03 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem Medicaid |
$767.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| 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 |
$1,115.50
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Humana KY Medicaid |
$767.24
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$775.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$782.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$691.61
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
EGD EXC TUMOR - POLYP(T
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
HCPCS 43216
|
| Hospital Charge Code |
761T1731
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.03 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$691.61
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
EGD GUIDE WIRE INSERTION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
76101744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
EGD GUIDE WIRE INSERTION
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
76101744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.30 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$288.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.30
|
| Rate for Payer: Anthem Medicaid |
$209.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$258.98
|
| Rate for Payer: Healthspan PPO |
$243.45
|
| Rate for Payer: Humana Medicaid |
$209.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$246.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.21
|
| Rate for Payer: Molina Healthcare Passport |
$209.03
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$170.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.12
|
|
|
EGD GUIDE WIRE INSERTION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
76101744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$1,097.45 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| 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 |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
EGD GUIDE WIRE INSERTION(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
761P1744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.30 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$288.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.30
|
| Rate for Payer: Anthem Medicaid |
$209.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$258.98
|
| Rate for Payer: Healthspan PPO |
$243.45
|
| Rate for Payer: Humana Medicaid |
$209.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$246.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.21
|
| Rate for Payer: Molina Healthcare Passport |
$209.03
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$170.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.12
|
|
|
EGD LESION ABLATION
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 43270
|
| Hospital Charge Code |
76101757
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.23 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.23
|
| Rate for Payer: Anthem Medicaid |
$196.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$980.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$405.53
|
| Rate for Payer: Healthspan PPO |
$939.05
|
| Rate for Payer: Humana Medicaid |
$196.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$318.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$200.84
|
| Rate for Payer: Molina Healthcare Passport |
$196.90
|
| Rate for Payer: Multiplan PHCS |
$588.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$686.00
|
| Rate for Payer: UHCCP Medicaid |
$198.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$198.87
|
|
|
EGD LESION ABLATION
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 43270
|
| Hospital Charge Code |
76101757
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem Medicaid |
$337.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| 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 |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Humana KY Medicaid |
$337.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$340.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.80
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
EGD LESION ABLATION
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS 43270
|
| Hospital Charge Code |
76101757
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.80
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
EGD LESION ABLATION(P
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 43270
|
| Hospital Charge Code |
761P1757
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.23 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.23
|
| Rate for Payer: Anthem Medicaid |
$196.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$980.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$405.53
|
| Rate for Payer: Healthspan PPO |
$939.05
|
| Rate for Payer: Humana Medicaid |
$196.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$318.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$200.84
|
| Rate for Payer: Molina Healthcare Passport |
$196.90
|
| Rate for Payer: Multiplan PHCS |
$588.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$686.00
|
| Rate for Payer: UHCCP Medicaid |
$198.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$198.87
|
|
|
EGD PLACE GASTROSTOMY TUBE
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
76101742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
EGD PLACE GASTROSTOMY TUBE
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
76101742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
EGD PLACE GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
76101742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.31 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$383.86
|
| Rate for Payer: Anthem Medicaid |
$288.31
|
| 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: Cigna Commercial |
$348.19
|
| Rate for Payer: Healthspan PPO |
$323.72
|
| Rate for Payer: Humana Medicaid |
$288.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.08
|
| Rate for Payer: Molina Healthcare Passport |
$288.31
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.19
|
|
|
EGD PLACE GASTROSTOMY TUBE(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
761P1742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.31 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$383.86
|
| Rate for Payer: Anthem Medicaid |
$288.31
|
| 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: Cigna Commercial |
$348.19
|
| Rate for Payer: Healthspan PPO |
$323.72
|
| Rate for Payer: Humana Medicaid |
$288.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.08
|
| Rate for Payer: Molina Healthcare Passport |
$288.31
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.19
|
|
|
EGD REMOVE FOREIGN BODY
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
76101743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.27 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$306.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$172.27
|
| Rate for Payer: Anthem Medicaid |
$225.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$276.40
|
| Rate for Payer: Healthspan PPO |
$258.40
|
| Rate for Payer: Humana Medicaid |
$225.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$262.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$229.61
|
| Rate for Payer: Molina Healthcare Passport |
$225.11
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$180.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.36
|
|
|
EGD REMOVE FOREIGN BODY
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
76101743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$1,097.45 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| 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 |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
EGD REMOVE FOREIGN BODY
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
76101743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
EGD REMOVE FOREIGN BODY(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
761P1743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.27 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$306.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$172.27
|
| Rate for Payer: Anthem Medicaid |
$225.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$276.40
|
| Rate for Payer: Healthspan PPO |
$258.40
|
| Rate for Payer: Humana Medicaid |
$225.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$262.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$229.61
|
| Rate for Payer: Molina Healthcare Passport |
$225.11
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$180.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.36
|
|
|
EGD REMOVE LESION SNARE
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
76101747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna Commercial |
$333.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$187.34
|
| Rate for Payer: Anthem Medicaid |
$242.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$915.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$300.68
|
| Rate for Payer: Healthspan PPO |
$281.02
|
| Rate for Payer: Humana Medicaid |
$242.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.25
|
| Rate for Payer: Molina Healthcare Passport |
$242.40
|
| Rate for Payer: Multiplan PHCS |
$549.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$640.50
|
| Rate for Payer: UHCCP Medicaid |
$196.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.82
|
|
|
EGD REMOVE LESION SNARE
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
76101747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.95 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem Medicaid |
$314.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| 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 |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Humana KY Medicaid |
$314.67
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$317.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$320.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$283.65
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
EGD REMOVE LESION SNARE
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
76101747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.95 |
| Max. Negotiated Rate |
$878.40 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$283.65
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
EGD REMOVE LESION SNARE(P
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
761P1747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna Commercial |
$333.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$187.34
|
| Rate for Payer: Anthem Medicaid |
$242.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$915.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$300.68
|
| Rate for Payer: Healthspan PPO |
$281.02
|
| Rate for Payer: Humana Medicaid |
$242.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.25
|
| Rate for Payer: Molina Healthcare Passport |
$242.40
|
| Rate for Payer: Multiplan PHCS |
$549.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$640.50
|
| Rate for Payer: UHCCP Medicaid |
$196.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.82
|
|
|
EGD TUBE/CATH INSERTION
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 43241
|
| Hospital Charge Code |
76101739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.01 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$237.80
|
| Rate for Payer: Anthem Medicaid |
$174.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$214.54
|
| Rate for Payer: Healthspan PPO |
$200.54
|
| Rate for Payer: Humana Medicaid |
$174.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$203.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.49
|
| Rate for Payer: Molina Healthcare Passport |
$174.01
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.75
|
|
|
EGD TUBE/CATH INSERTION
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 43241
|
| Hospital Charge Code |
76101739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| 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 |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.32
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
EGD TUBE/CATH INSERTION
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 43241
|
| Hospital Charge Code |
76101739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
