|
EGD TUBE/CATH INSERTION(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 43241
|
| Hospital Charge Code |
761P1739
|
|
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 VARICES LIGATION
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
76101740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.72 |
| Max. Negotiated Rate |
$895.00 |
| Rate for Payer: Aetna Commercial |
$453.26
|
| Rate for Payer: Anthem Medicaid |
$237.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$895.00
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$406.41
|
| Rate for Payer: Healthspan PPO |
$382.24
|
| Rate for Payer: Humana Medicaid |
$237.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.47
|
| Rate for Payer: Molina Healthcare Passport |
$237.72
|
| Rate for Payer: Multiplan PHCS |
$537.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$626.50
|
| Rate for Payer: UHCCP Medicaid |
$313.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.10
|
|
|
EGD VARICES LIGATION
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
76101740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Anthem Medicaid |
$307.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$698.10
|
| 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 |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$742.85
|
| Rate for Payer: First Health Commercial |
$850.25
|
| Rate for Payer: Humana Commercial |
$760.75
|
| Rate for Payer: Humana KY Medicaid |
$307.79
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$310.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$660.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$313.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$787.60
|
| Rate for Payer: Ohio Health Group HMO |
$671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.45
|
| Rate for Payer: PHCS Commercial |
$859.20
|
| Rate for Payer: United Healthcare All Payer |
$787.60
|
|
|
EGD VARICES LIGATION
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
76101740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$859.20 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$698.10
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$742.85
|
| Rate for Payer: First Health Commercial |
$850.25
|
| Rate for Payer: Humana Commercial |
$760.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$660.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$787.60
|
| Rate for Payer: Ohio Health Group HMO |
$671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.45
|
| Rate for Payer: PHCS Commercial |
$859.20
|
| Rate for Payer: United Healthcare All Payer |
$787.60
|
|
|
EGD VARICES LIGATION(P
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
761P1740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.72 |
| Max. Negotiated Rate |
$895.00 |
| Rate for Payer: Aetna Commercial |
$453.26
|
| Rate for Payer: Anthem Medicaid |
$237.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$895.00
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$406.41
|
| Rate for Payer: Healthspan PPO |
$382.24
|
| Rate for Payer: Humana Medicaid |
$237.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.47
|
| Rate for Payer: Molina Healthcare Passport |
$237.72
|
| Rate for Payer: Multiplan PHCS |
$537.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$626.50
|
| Rate for Payer: UHCCP Medicaid |
$313.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.10
|
|
|
EGD WITH GASTRORRHAPHY
|
Facility
|
OP
|
$2,874.65
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
76101801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.70 |
| Max. Negotiated Rate |
$2,759.66 |
| Rate for Payer: Aetna Commercial |
$2,213.48
|
| Rate for Payer: Anthem Medicaid |
$988.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,242.23
|
| 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 |
$1,437.33
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Cigna Commercial |
$2,385.96
|
| Rate for Payer: First Health Commercial |
$2,730.92
|
| Rate for Payer: Humana Commercial |
$2,443.45
|
| Rate for Payer: Humana KY Medicaid |
$988.59
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$998.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,357.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,121.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,008.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,155.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$574.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$891.14
|
| Rate for Payer: PHCS Commercial |
$2,759.66
|
| Rate for Payer: United Healthcare All Payer |
$2,529.69
|
|
|
EGD WITH GASTRORRHAPHY
|
Professional
|
Both
|
$2,874.65
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
76101801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,874.65 |
| Rate for Payer: Anthem Medicaid |
$75.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,874.65
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$75.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.50
|
| Rate for Payer: Molina Healthcare Passport |
$75.00
|
| Rate for Payer: Multiplan PHCS |
$1,724.79
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,012.26
|
| Rate for Payer: UHCCP Medicaid |
$1,006.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.75
|
|
|
EGD WITH GASTRORRHAPHY
|
Facility
|
IP
|
$2,874.65
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
76101801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.70 |
| Max. Negotiated Rate |
$2,759.66 |
| Rate for Payer: Aetna Commercial |
$2,213.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,242.23
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Cigna Commercial |
$2,385.96
|
| Rate for Payer: First Health Commercial |
$2,730.92
|
| Rate for Payer: Humana Commercial |
$2,443.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,357.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,121.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$862.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,155.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$574.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$891.14
|
| Rate for Payer: PHCS Commercial |
$2,759.66
|
| Rate for Payer: United Healthcare All Payer |
$2,529.69
|
|
|
EGD WITH GASTRORRHAPHY(T
|
Facility
|
IP
|
$2,874.65
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
761T1801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.70 |
| Max. Negotiated Rate |
$2,759.66 |
| Rate for Payer: Aetna Commercial |
$2,213.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,242.23
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Cigna Commercial |
$2,385.96
|
| Rate for Payer: First Health Commercial |
$2,730.92
|
| Rate for Payer: Humana Commercial |
$2,443.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,357.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,121.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$862.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,155.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$574.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$891.14
|
| Rate for Payer: PHCS Commercial |
$2,759.66
|
| Rate for Payer: United Healthcare All Payer |
$2,529.69
|
|
|
EGD WITH GASTRORRHAPHY(T
|
Facility
|
OP
|
$2,874.65
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
761T1801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.70 |
| Max. Negotiated Rate |
$2,759.66 |
| Rate for Payer: Aetna Commercial |
$2,213.48
|
| Rate for Payer: Anthem Medicaid |
$988.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,242.23
|
| 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 |
$1,437.33
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Cigna Commercial |
$2,385.96
|
| Rate for Payer: First Health Commercial |
$2,730.92
|
| Rate for Payer: Humana Commercial |
$2,443.45
|
| Rate for Payer: Humana KY Medicaid |
$988.59
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$998.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,357.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,121.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,008.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,155.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$574.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$891.14
|
| Rate for Payer: PHCS Commercial |
$2,759.66
|
| Rate for Payer: United Healthcare All Payer |
$2,529.69
|
|
|
EGD W/THRML TXMNT GERD
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 43257
|
| Hospital Charge Code |
76101750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$4,636.52 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,636.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,470.93
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Humana KY Medicaid |
$223.54
|
| Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
EGD W/THRML TXMNT GERD
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 43257
|
| Hospital Charge Code |
76101750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
EGD W/THRML TXMNT GERD
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 43257
|
| Hospital Charge Code |
76101750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$476.96
|
| Rate for Payer: Anthem Medicaid |
$228.65
|
| 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 |
$431.75
|
| Rate for Payer: Healthspan PPO |
$402.23
|
| Rate for Payer: Humana Medicaid |
$228.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.22
|
| Rate for Payer: Molina Healthcare Passport |
$228.65
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.94
|
|
|
EGD W/THRML TXMNT GERD(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 43257
|
| Hospital Charge Code |
761P1750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$476.96
|
| Rate for Payer: Anthem Medicaid |
$228.65
|
| 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 |
$431.75
|
| Rate for Payer: Healthspan PPO |
$402.23
|
| Rate for Payer: Humana Medicaid |
$228.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.22
|
| Rate for Payer: Molina Healthcare Passport |
$228.65
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.94
|
|
|
EGG WHITE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
EGG WHITE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
EKG CANCER CENTER (T
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
730T0007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
EKG CANCER CENTER (T
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
730T0007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
EKG INTERPRET & REPORT PREVE
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS G0405
|
| Hospital Charge Code |
73000102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.86
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
|
|
EKG INT/RE CANCER CENTER (P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 93010
|
| Hospital Charge Code |
730P0007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Anthem Medicaid |
$9.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$13.30
|
| Rate for Payer: Healthspan PPO |
$14.09
|
| Rate for Payer: Humana Medicaid |
$9.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.71
|
| Rate for Payer: Molina Healthcare Passport |
$9.52
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.62
|
|
|
EKG REG CANCER CENTER
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem Medicaid |
$94.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Humana KY Medicaid |
$94.57
|
| Rate for Payer: Kentucky WC Medicaid |
$95.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.25
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
EKG REG CANCER CENTER
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.25
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
EKG REG CANCER CENTER
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$33.91
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$38.05
|
| Rate for Payer: Healthspan PPO |
$31.87
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
|
|
EKG REGULAR
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.30
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.35
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
EKG REGULAR
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$33.91
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$285.00
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$38.05
|
| Rate for Payer: Healthspan PPO |
$31.87
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$199.50
|
| Rate for Payer: UHCCP Medicaid |
$99.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
|
