ESOPHAGOSCOPY BALLOON <30MM(T
|
Facility
|
IP
|
$3,130.40
|
|
Service Code
|
HCPCS 43220
|
Hospital Charge Code |
761T1732
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$406.95 |
Max. Negotiated Rate |
$3,005.18 |
Rate for Payer: Aetna Commercial |
$2,410.41
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.71
|
Rate for Payer: Cash Price |
$1,565.20
|
Rate for Payer: Cigna Commercial |
$2,598.23
|
Rate for Payer: First Health Commercial |
$2,973.88
|
Rate for Payer: Humana Commercial |
$2,660.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.93
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,310.24
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$939.12
|
Rate for Payer: Ohio Health Choice Commercial |
$2,754.75
|
Rate for Payer: Ohio Health Group HMO |
$2,347.80
|
Rate for Payer: Ohio Health Group PPO Differential |
$626.08
|
Rate for Payer: Ohio Health Group PPO No Differential |
$406.95
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$970.42
|
Rate for Payer: PHCS Commercial |
$3,005.18
|
Rate for Payer: United Healthcare All Payer |
$2,754.75
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$4,636.52
|
|
Service Code
|
CPT 43229
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$3,311.80 |
Max. Negotiated Rate |
$4,636.52 |
Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,636.52
|
Rate for Payer: CareSource Just4Me Medicare |
$4,470.93
|
Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
|
ESOPHAGOSCOPY LESION ABLATE
|
Professional
|
Both
|
$405.00
|
|
Service Code
|
HCPCS 43229
|
Hospital Charge Code |
76101733
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$160.90 |
Max. Negotiated Rate |
$938.67 |
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$160.90
|
Rate for Payer: Anthem Medicaid |
$167.11
|
Rate for Payer: Buckeye Medicare Advantage |
$405.00
|
Rate for Payer: Cash Price |
$202.50
|
Rate for Payer: Cash Price |
$202.50
|
Rate for Payer: Cigna Commercial |
$344.54
|
Rate for Payer: Healthspan PPO |
$938.67
|
Rate for Payer: Humana Medicaid |
$167.11
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$270.44
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.45
|
Rate for Payer: Molina Healthcare Passport |
$167.11
|
Rate for Payer: Multiplan PHCS |
$243.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$283.50
|
Rate for Payer: UHCCP Medicaid |
$168.94
|
Rate for Payer: Wellcare CHIP/Medicaid |
$168.78
|
|
ESOPHAGOSCOPY LESION ABLATE
|
Facility
|
OP
|
$405.00
|
|
Service Code
|
HCPCS 43229
|
Hospital Charge Code |
76101733
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$52.65 |
Max. Negotiated Rate |
$4,636.52 |
Rate for Payer: Aetna Commercial |
$311.85
|
Rate for Payer: Anthem Medicaid |
$139.28
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
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 |
$202.50
|
Rate for Payer: Cash Price |
$202.50
|
Rate for Payer: Cigna Commercial |
$336.15
|
Rate for Payer: First Health Commercial |
$384.75
|
Rate for Payer: Humana Commercial |
$344.25
|
Rate for Payer: Humana KY Medicaid |
$139.28
|
Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
Rate for Payer: Kentucky WC Medicaid |
$140.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
Rate for Payer: Molina Healthcare Medicaid |
$142.07
|
Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
Rate for Payer: Ohio Health Group HMO |
$303.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$81.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$52.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.55
|
Rate for Payer: PHCS Commercial |
$388.80
|
Rate for Payer: United Healthcare All Payer |
$356.40
|
|
ESOPHAGOSCOPY LESION ABLATE
|
Facility
|
IP
|
$405.00
|
|
Service Code
|
HCPCS 43229
|
Hospital Charge Code |
76101733
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$52.65 |
Max. Negotiated Rate |
$388.80 |
Rate for Payer: Aetna Commercial |
$311.85
|
Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
Rate for Payer: Cash Price |
$202.50
|
Rate for Payer: Cigna Commercial |
$336.15
|
Rate for Payer: First Health Commercial |
$384.75
|
Rate for Payer: Humana Commercial |
$344.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$121.50
|
Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
Rate for Payer: Ohio Health Group HMO |
$303.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$81.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$52.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.55
|
Rate for Payer: PHCS Commercial |
$388.80
|
Rate for Payer: United Healthcare All Payer |
$356.40
|
|
ESOPHAGOSCOPY LESION ABLATE(P
|
Professional
|
Both
|
$405.00
|
|
Service Code
|
HCPCS 43229
|
Hospital Charge Code |
761P1733
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$160.90 |
Max. Negotiated Rate |
$938.67 |
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$160.90
|
Rate for Payer: Anthem Medicaid |
$167.11
|
Rate for Payer: Buckeye Medicare Advantage |
$405.00
|
Rate for Payer: Cash Price |
$202.50
|
Rate for Payer: Cash Price |
$202.50
|
Rate for Payer: Cigna Commercial |
$344.54
|
Rate for Payer: Healthspan PPO |
$938.67
|
Rate for Payer: Humana Medicaid |
$167.11
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$270.44
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.45
|
Rate for Payer: Molina Healthcare Passport |
$167.11
|
Rate for Payer: Multiplan PHCS |
$243.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$283.50
|
Rate for Payer: UHCCP Medicaid |
$168.94
|
Rate for Payer: Wellcare CHIP/Medicaid |
$168.78
|
|
ESOPHAGOSCOPY(P
|
Professional
|
Both
|
$550.00
|
|
Service Code
|
HCPCS 43200
|
Hospital Charge Code |
761P1726
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$87.50 |
Max. Negotiated Rate |
$550.00 |
Rate for Payer: Aetna Commercial |
$155.63
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.50
|
Rate for Payer: Anthem Medicaid |
$107.69
|
Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
Rate for Payer: Cash Price |
$275.00
|
Rate for Payer: Cash Price |
$275.00
|
Rate for Payer: Cigna Commercial |
$149.16
|
Rate for Payer: Healthspan PPO |
$255.38
|
Rate for Payer: Humana Medicaid |
$107.69
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.80
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.84
|
Rate for Payer: Molina Healthcare Passport |
$107.69
|
Rate for Payer: Multiplan PHCS |
$330.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
Rate for Payer: UHCCP Medicaid |
$91.88
|
Rate for Payer: Wellcare CHIP/Medicaid |
$108.77
|
|
ESOPHAGOSCOPY(P
|
Professional
|
Both
|
$550.00
|
|
Service Code
|
HCPCS 43202
|
Hospital Charge Code |
761P1728
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$97.44 |
Max. Negotiated Rate |
$550.00 |
Rate for Payer: Aetna Commercial |
$173.30
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.44
|
Rate for Payer: Anthem Medicaid |
$127.63
|
Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
Rate for Payer: Cash Price |
$275.00
|
Rate for Payer: Cash Price |
$275.00
|
Rate for Payer: Cigna Commercial |
$161.26
|
Rate for Payer: Healthspan PPO |
$334.37
|
Rate for Payer: Humana Medicaid |
$127.63
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.35
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.18
|
Rate for Payer: Molina Healthcare Passport |
$127.63
|
Rate for Payer: Multiplan PHCS |
$330.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
Rate for Payer: UHCCP Medicaid |
$102.31
|
Rate for Payer: Wellcare CHIP/Medicaid |
$128.91
|
|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Professional
|
Both
|
$4,152.00
|
|
Service Code
|
HCPCS 43215
|
Hospital Charge Code |
76101730
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$132.01 |
Max. Negotiated Rate |
$4,152.00 |
Rate for Payer: Aetna Commercial |
$234.81
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$132.01
|
Rate for Payer: Anthem Medicaid |
$176.79
|
Rate for Payer: Buckeye Medicare Advantage |
$4,152.00
|
Rate for Payer: Cash Price |
$2,076.00
|
Rate for Payer: Cash Price |
$2,076.00
|
Rate for Payer: Cigna Commercial |
$217.90
|
Rate for Payer: Healthspan PPO |
$198.02
|
Rate for Payer: Humana Medicaid |
$176.79
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.12
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.33
|
Rate for Payer: Molina Healthcare Passport |
$176.79
|
Rate for Payer: Multiplan PHCS |
$2,491.20
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,906.40
|
Rate for Payer: UHCCP Medicaid |
$138.61
|
Rate for Payer: Wellcare CHIP/Medicaid |
$178.56
|
|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Facility
|
OP
|
$3,302.00
|
|
Service Code
|
HCPCS 43215
|
Hospital Charge Code |
761T1730
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$429.26 |
Max. Negotiated Rate |
$3,169.92 |
Rate for Payer: Aetna Commercial |
$2,542.54
|
Rate for Payer: Anthem Medicaid |
$1,135.56
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.56
|
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 |
$1,651.00
|
Rate for Payer: Cash Price |
$1,651.00
|
Rate for Payer: Cigna Commercial |
$2,740.66
|
Rate for Payer: First Health Commercial |
$3,136.90
|
Rate for Payer: Humana Commercial |
$2,806.70
|
Rate for Payer: Humana KY Medicaid |
$1,135.56
|
Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
Rate for Payer: Kentucky WC Medicaid |
$1,147.11
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,707.64
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,436.88
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
Rate for Payer: Molina Healthcare Medicaid |
$1,158.34
|
Rate for Payer: Ohio Health Choice Commercial |
$2,905.76
|
Rate for Payer: Ohio Health Group HMO |
$2,476.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$660.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$429.26
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.62
|
Rate for Payer: PHCS Commercial |
$3,169.92
|
Rate for Payer: United Healthcare All Payer |
$2,905.76
|
|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Facility
|
IP
|
$3,302.00
|
|
Service Code
|
HCPCS 43215
|
Hospital Charge Code |
761T1730
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$429.26 |
Max. Negotiated Rate |
$3,169.92 |
Rate for Payer: Aetna Commercial |
$2,542.54
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.56
|
Rate for Payer: Cash Price |
$1,651.00
|
Rate for Payer: Cigna Commercial |
$2,740.66
|
Rate for Payer: First Health Commercial |
$3,136.90
|
Rate for Payer: Humana Commercial |
$2,806.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,707.64
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,436.88
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$990.60
|
Rate for Payer: Ohio Health Choice Commercial |
$2,905.76
|
Rate for Payer: Ohio Health Group HMO |
$2,476.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$660.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$429.26
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.62
|
Rate for Payer: PHCS Commercial |
$3,169.92
|
Rate for Payer: United Healthcare All Payer |
$2,905.76
|
|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Facility
|
IP
|
$4,152.00
|
|
Service Code
|
HCPCS 43215
|
Hospital Charge Code |
76101730
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$539.76 |
Max. Negotiated Rate |
$3,985.92 |
Rate for Payer: Aetna Commercial |
$3,197.04
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,238.56
|
Rate for Payer: Cash Price |
$2,076.00
|
Rate for Payer: Cigna Commercial |
$3,446.16
|
Rate for Payer: First Health Commercial |
$3,944.40
|
Rate for Payer: Humana Commercial |
$3,529.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,404.64
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,064.18
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,245.60
|
Rate for Payer: Ohio Health Choice Commercial |
$3,653.76
|
Rate for Payer: Ohio Health Group HMO |
$3,114.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$830.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$539.76
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,287.12
|
Rate for Payer: PHCS Commercial |
$3,985.92
|
Rate for Payer: United Healthcare All Payer |
$3,653.76
|
|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Facility
|
OP
|
$4,152.00
|
|
Service Code
|
HCPCS 43215
|
Hospital Charge Code |
76101730
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$539.76 |
Max. Negotiated Rate |
$3,985.92 |
Rate for Payer: Aetna Commercial |
$3,197.04
|
Rate for Payer: Anthem Medicaid |
$1,427.87
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,238.56
|
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 |
$2,076.00
|
Rate for Payer: Cash Price |
$2,076.00
|
Rate for Payer: Cigna Commercial |
$3,446.16
|
Rate for Payer: First Health Commercial |
$3,944.40
|
Rate for Payer: Humana Commercial |
$3,529.20
|
Rate for Payer: Humana KY Medicaid |
$1,427.87
|
Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
Rate for Payer: Kentucky WC Medicaid |
$1,442.40
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,404.64
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,064.18
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
Rate for Payer: Molina Healthcare Medicaid |
$1,456.52
|
Rate for Payer: Ohio Health Choice Commercial |
$3,653.76
|
Rate for Payer: Ohio Health Group HMO |
$3,114.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$830.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$539.76
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,287.12
|
Rate for Payer: PHCS Commercial |
$3,985.92
|
Rate for Payer: United Healthcare All Payer |
$3,653.76
|
|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Professional
|
Both
|
$850.00
|
|
Service Code
|
HCPCS 43215
|
Hospital Charge Code |
761P1730
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$132.01 |
Max. Negotiated Rate |
$850.00 |
Rate for Payer: Aetna Commercial |
$234.81
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$132.01
|
Rate for Payer: Anthem Medicaid |
$176.79
|
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 |
$217.90
|
Rate for Payer: Healthspan PPO |
$198.02
|
Rate for Payer: Humana Medicaid |
$176.79
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.12
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.33
|
Rate for Payer: Molina Healthcare Passport |
$176.79
|
Rate for Payer: Multiplan PHCS |
$510.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
Rate for Payer: UHCCP Medicaid |
$138.61
|
Rate for Payer: Wellcare CHIP/Medicaid |
$178.56
|
|
ESOPHAGOSCOPY RIGID BALLOON
|
Facility
|
OP
|
$385.00
|
|
Service Code
|
HCPCS 43195
|
Hospital Charge Code |
76101725
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$50.05 |
Max. Negotiated Rate |
$4,636.52 |
Rate for Payer: Aetna Commercial |
$296.45
|
Rate for Payer: Anthem Medicaid |
$132.40
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
Rate for Payer: Anthem POS/PPO/Traditional |
$300.30
|
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 |
$192.50
|
Rate for Payer: Cash Price |
$192.50
|
Rate for Payer: Cigna Commercial |
$319.55
|
Rate for Payer: First Health Commercial |
$365.75
|
Rate for Payer: Humana Commercial |
$327.25
|
Rate for Payer: Humana KY Medicaid |
$132.40
|
Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
Rate for Payer: Kentucky WC Medicaid |
$133.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$315.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.13
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
Rate for Payer: Molina Healthcare Medicaid |
$135.06
|
Rate for Payer: Ohio Health Choice Commercial |
$338.80
|
Rate for Payer: Ohio Health Group HMO |
$288.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$77.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$50.05
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.35
|
Rate for Payer: PHCS Commercial |
$369.60
|
Rate for Payer: United Healthcare All Payer |
$338.80
|
|
ESOPHAGOSCOPY RIGID BALLOON
|
Facility
|
IP
|
$385.00
|
|
Service Code
|
HCPCS 43195
|
Hospital Charge Code |
76101725
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$50.05 |
Max. Negotiated Rate |
$369.60 |
Rate for Payer: First Health Commercial |
$365.75
|
Rate for Payer: Aetna Commercial |
$296.45
|
Rate for Payer: Anthem POS/PPO/Traditional |
$300.30
|
Rate for Payer: Cash Price |
$192.50
|
Rate for Payer: Cigna Commercial |
$319.55
|
Rate for Payer: Humana Commercial |
$327.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$315.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.13
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$115.50
|
Rate for Payer: Ohio Health Choice Commercial |
$338.80
|
Rate for Payer: Ohio Health Group HMO |
$288.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$77.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$50.05
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.35
|
Rate for Payer: PHCS Commercial |
$369.60
|
Rate for Payer: United Healthcare All Payer |
$338.80
|
|
ESOPHAGOSCOPY RIGID BALLOON
|
Professional
|
Both
|
$385.00
|
|
Service Code
|
HCPCS 43195
|
Hospital Charge Code |
76101725
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$134.75 |
Max. Negotiated Rate |
$385.00 |
Rate for Payer: Anthem Medicaid |
$144.48
|
Rate for Payer: Buckeye Medicare Advantage |
$385.00
|
Rate for Payer: Cash Price |
$192.50
|
Rate for Payer: Cash Price |
$192.50
|
Rate for Payer: Cigna Commercial |
$297.01
|
Rate for Payer: Healthspan PPO |
$245.39
|
Rate for Payer: Humana Medicaid |
$144.48
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.98
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$147.37
|
Rate for Payer: Molina Healthcare Passport |
$144.48
|
Rate for Payer: Multiplan PHCS |
$231.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$269.50
|
Rate for Payer: UHCCP Medicaid |
$134.75
|
Rate for Payer: Wellcare CHIP/Medicaid |
$145.92
|
|
ESOPHAGOSCOPY RIGID BALLOON(P
|
Professional
|
Both
|
$385.00
|
|
Service Code
|
HCPCS 43195
|
Hospital Charge Code |
761P1725
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$134.75 |
Max. Negotiated Rate |
$385.00 |
Rate for Payer: Anthem Medicaid |
$144.48
|
Rate for Payer: Buckeye Medicare Advantage |
$385.00
|
Rate for Payer: Cash Price |
$192.50
|
Rate for Payer: Cash Price |
$192.50
|
Rate for Payer: Cigna Commercial |
$297.01
|
Rate for Payer: Healthspan PPO |
$245.39
|
Rate for Payer: Humana Medicaid |
$144.48
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.98
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$147.37
|
Rate for Payer: Molina Healthcare Passport |
$144.48
|
Rate for Payer: Multiplan PHCS |
$231.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$269.50
|
Rate for Payer: UHCCP Medicaid |
$134.75
|
Rate for Payer: Wellcare CHIP/Medicaid |
$145.92
|
|
ESOPHAGOSCOPY RIGID TRNSO D(P
|
Professional
|
Both
|
$355.00
|
|
Service Code
|
HCPCS 43191
|
Hospital Charge Code |
761P1723
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$101.16 |
Max. Negotiated Rate |
$355.00 |
Rate for Payer: Anthem Medicaid |
$101.16
|
Rate for Payer: Buckeye Medicare Advantage |
$355.00
|
Rate for Payer: Cash Price |
$177.50
|
Rate for Payer: Cash Price |
$177.50
|
Rate for Payer: Cigna Commercial |
$208.27
|
Rate for Payer: Healthspan PPO |
$171.90
|
Rate for Payer: Humana Medicaid |
$101.16
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.51
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.18
|
Rate for Payer: Molina Healthcare Passport |
$101.16
|
Rate for Payer: Multiplan PHCS |
$213.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.50
|
Rate for Payer: UHCCP Medicaid |
$124.25
|
Rate for Payer: Wellcare CHIP/Medicaid |
$102.17
|
|
ESOPHAGOSCOPY RIGID TRNSO DX
|
Professional
|
Both
|
$355.00
|
|
Service Code
|
HCPCS 43191
|
Hospital Charge Code |
76101723
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$101.16 |
Max. Negotiated Rate |
$355.00 |
Rate for Payer: Anthem Medicaid |
$101.16
|
Rate for Payer: Buckeye Medicare Advantage |
$355.00
|
Rate for Payer: Cash Price |
$177.50
|
Rate for Payer: Cash Price |
$177.50
|
Rate for Payer: Cigna Commercial |
$208.27
|
Rate for Payer: Healthspan PPO |
$171.90
|
Rate for Payer: Humana Medicaid |
$101.16
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.51
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.18
|
Rate for Payer: Molina Healthcare Passport |
$101.16
|
Rate for Payer: Multiplan PHCS |
$213.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.50
|
Rate for Payer: UHCCP Medicaid |
$124.25
|
Rate for Payer: Wellcare CHIP/Medicaid |
$102.17
|
|
ESOPHAGOSCOPY RIGID TRNSO DX
|
Facility
|
IP
|
$355.00
|
|
Service Code
|
HCPCS 43191
|
Hospital Charge Code |
76101723
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$46.15 |
Max. Negotiated Rate |
$340.80 |
Rate for Payer: Aetna Commercial |
$273.35
|
Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
Rate for Payer: Cash Price |
$177.50
|
Rate for Payer: Cigna Commercial |
$294.65
|
Rate for Payer: First Health Commercial |
$337.25
|
Rate for Payer: Humana Commercial |
$301.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
Rate for Payer: Ohio Health Group HMO |
$266.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
Rate for Payer: PHCS Commercial |
$340.80
|
Rate for Payer: United Healthcare All Payer |
$312.40
|
|
ESOPHAGOSCOPY RIGID TRNSO DX
|
Facility
|
OP
|
$355.00
|
|
Service Code
|
HCPCS 43191
|
Hospital Charge Code |
76101723
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$46.15 |
Max. Negotiated Rate |
$2,303.66 |
Rate for Payer: Aetna Commercial |
$273.35
|
Rate for Payer: Anthem Medicaid |
$122.08
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
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 |
$177.50
|
Rate for Payer: Cash Price |
$177.50
|
Rate for Payer: Cigna Commercial |
$294.65
|
Rate for Payer: First Health Commercial |
$337.25
|
Rate for Payer: Humana Commercial |
$301.75
|
Rate for Payer: Humana KY Medicaid |
$122.08
|
Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
Rate for Payer: Kentucky WC Medicaid |
$123.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
Rate for Payer: Molina Healthcare Medicaid |
$124.53
|
Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
Rate for Payer: Ohio Health Group HMO |
$266.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
Rate for Payer: PHCS Commercial |
$340.80
|
Rate for Payer: United Healthcare All Payer |
$312.40
|
|
ESOPHAGOSCOPY(T
|
Facility
|
IP
|
$2,773.75
|
|
Service Code
|
HCPCS 43202
|
Hospital Charge Code |
761T1728
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$360.59 |
Max. Negotiated Rate |
$2,662.80 |
Rate for Payer: Aetna Commercial |
$2,135.79
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,163.52
|
Rate for Payer: Cash Price |
$1,386.88
|
Rate for Payer: Cigna Commercial |
$2,302.21
|
Rate for Payer: First Health Commercial |
$2,635.06
|
Rate for Payer: Humana Commercial |
$2,357.69
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,274.48
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,047.03
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$832.12
|
Rate for Payer: Ohio Health Choice Commercial |
$2,440.90
|
Rate for Payer: Ohio Health Group HMO |
$2,080.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$554.75
|
Rate for Payer: Ohio Health Group PPO No Differential |
$360.59
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.86
|
Rate for Payer: PHCS Commercial |
$2,662.80
|
Rate for Payer: United Healthcare All Payer |
$2,440.90
|
|
ESOPHAGOSCOPY(T
|
Facility
|
OP
|
$2,684.13
|
|
Service Code
|
HCPCS 43200
|
Hospital Charge Code |
761T1726
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$348.94 |
Max. Negotiated Rate |
$2,576.76 |
Rate for Payer: Aetna Commercial |
$2,066.78
|
Rate for Payer: Anthem Medicaid |
$923.07
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,093.62
|
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 |
$1,342.07
|
Rate for Payer: Cash Price |
$1,342.07
|
Rate for Payer: Cigna Commercial |
$2,227.83
|
Rate for Payer: First Health Commercial |
$2,549.92
|
Rate for Payer: Humana Commercial |
$2,281.51
|
Rate for Payer: Humana KY Medicaid |
$923.07
|
Rate for Payer: Humana Medicare Advantage |
$783.89
|
Rate for Payer: Kentucky WC Medicaid |
$932.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,200.99
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,980.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
Rate for Payer: Molina Healthcare Medicaid |
$941.59
|
Rate for Payer: Ohio Health Choice Commercial |
$2,362.03
|
Rate for Payer: Ohio Health Group HMO |
$2,013.10
|
Rate for Payer: Ohio Health Group PPO Differential |
$536.83
|
Rate for Payer: Ohio Health Group PPO No Differential |
$348.94
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$832.08
|
Rate for Payer: PHCS Commercial |
$2,576.76
|
Rate for Payer: United Healthcare All Payer |
$2,362.03
|
|
ESOPHAGOSCOPY(T
|
Facility
|
IP
|
$2,684.13
|
|
Service Code
|
HCPCS 43200
|
Hospital Charge Code |
761T1726
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$348.94 |
Max. Negotiated Rate |
$2,576.76 |
Rate for Payer: Aetna Commercial |
$2,066.78
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,093.62
|
Rate for Payer: Cash Price |
$1,342.07
|
Rate for Payer: Cigna Commercial |
$2,227.83
|
Rate for Payer: First Health Commercial |
$2,549.92
|
Rate for Payer: Humana Commercial |
$2,281.51
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,200.99
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,980.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$805.24
|
Rate for Payer: Ohio Health Choice Commercial |
$2,362.03
|
Rate for Payer: Ohio Health Group HMO |
$2,013.10
|
Rate for Payer: Ohio Health Group PPO Differential |
$536.83
|
Rate for Payer: Ohio Health Group PPO No Differential |
$348.94
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$832.08
|
Rate for Payer: PHCS Commercial |
$2,576.76
|
Rate for Payer: United Healthcare All Payer |
$2,362.03
|
|