|
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
|
|
|
ESOPHAGOSCP RIG TRNSO REM FB
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 43194
|
| Hospital Charge Code |
76101724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$645.00 |
| Rate for Payer: Anthem Medicaid |
$131.80
|
| 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 |
$270.07
|
| Rate for Payer: Healthspan PPO |
$223.52
|
| Rate for Payer: Humana Medicaid |
$131.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$134.44
|
| Rate for Payer: Molina Healthcare Passport |
$131.80
|
| 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 |
$133.12
|
|
|
ESOPHAGOSCP RIG TRNSO REM FB
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 43194
|
| Hospital Charge Code |
76101724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$496.65
|
| Rate for Payer: Anthem Medicaid |
$221.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$503.10
|
| 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 |
$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 |
$1,645.47
|
| 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 |
$1,974.56
|
| 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
|
|
|
ESOPHAGOSCP RIG TRNSO REM FB
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
HCPCS 43194
|
| Hospital Charge Code |
76101724
|
|
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
|
|
|
ESOPHAGOSCP RIG TRNSO REM F(P
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 43194
|
| Hospital Charge Code |
761P1724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$645.00 |
| Rate for Payer: Anthem Medicaid |
$131.80
|
| 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 |
$270.07
|
| Rate for Payer: Healthspan PPO |
$223.52
|
| Rate for Payer: Humana Medicaid |
$131.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$134.44
|
| Rate for Payer: Molina Healthcare Passport |
$131.80
|
| 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 |
$133.12
|
|
|
ESOPHAGRAM AIR CONTRAST
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 74221
|
| Hospital Charge Code |
32000374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$189.12 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.66
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.07
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
ESOPHAGRAM AIR CONTRAST
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 74221
|
| Hospital Charge Code |
32000374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$222.43 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem Medicaid |
$67.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Humana KY Medicaid |
$67.75
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$68.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.07
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$648.89
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$463.49 |
| Max. Negotiated Rate |
$648.89 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
|
|
ESOPHAGUS MOTILITY STUDY
|
Professional
|
Both
|
$1,470.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$87.57 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: Aetna Commercial |
$281.95
|
| Rate for Payer: Anthem Medicaid |
$113.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,470.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$265.76
|
| Rate for Payer: Healthspan PPO |
$230.73
|
| Rate for Payer: Humana Medicaid |
$113.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$115.97
|
| Rate for Payer: Molina Healthcare Passport |
$113.70
|
| Rate for Payer: Multiplan PHCS |
$882.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,029.00
|
| Rate for Payer: UHCCP Medicaid |
$514.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$114.84
|
|
|
ESOPHAGUS MOTILITY STUDY
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$1,411.20 |
| Rate for Payer: Aetna Commercial |
$1,131.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,146.60
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$1,220.10
|
| Rate for Payer: First Health Commercial |
$1,396.50
|
| Rate for Payer: Humana Commercial |
$1,249.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,205.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,084.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$441.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,293.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,102.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.70
|
| Rate for Payer: PHCS Commercial |
$1,411.20
|
| Rate for Payer: United Healthcare All Payer |
$1,293.60
|
|
|
ESOPHAGUS MOTILITY STUDY
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$1,411.20 |
| Rate for Payer: Aetna Commercial |
$1,131.90
|
| Rate for Payer: Anthem Medicaid |
$505.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,146.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$1,220.10
|
| Rate for Payer: First Health Commercial |
$1,396.50
|
| Rate for Payer: Humana Commercial |
$1,249.50
|
| Rate for Payer: Humana KY Medicaid |
$505.53
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$510.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,205.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,084.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$515.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,293.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,102.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.70
|
| Rate for Payer: PHCS Commercial |
$1,411.20
|
| Rate for Payer: United Healthcare All Payer |
$1,293.60
|
|
|
ESOPHAGUS MOTILITY STUDY(P
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
750P0001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$87.57 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$281.95
|
| Rate for Payer: Anthem Medicaid |
$113.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$360.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$265.76
|
| Rate for Payer: Healthspan PPO |
$230.73
|
| Rate for Payer: Humana Medicaid |
$113.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$115.97
|
| Rate for Payer: Molina Healthcare Passport |
$113.70
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$252.00
|
| Rate for Payer: UHCCP Medicaid |
$126.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$114.84
|
|
|
ESOPHAGUS MOTILITY STUDY(T
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
750T0001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$1,065.60 |
| Rate for Payer: Aetna Commercial |
$854.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.80
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$921.30
|
| Rate for Payer: First Health Commercial |
$1,054.50
|
| Rate for Payer: Humana Commercial |
$943.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$910.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$819.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$976.80
|
| Rate for Payer: Ohio Health Group HMO |
$832.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.10
|
| Rate for Payer: PHCS Commercial |
$1,065.60
|
| Rate for Payer: United Healthcare All Payer |
$976.80
|
|
|
ESOPHAGUS MOTILITY STUDY(T
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
750T0001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$1,065.60 |
| Rate for Payer: Aetna Commercial |
$854.70
|
| Rate for Payer: Anthem Medicaid |
$381.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$921.30
|
| Rate for Payer: First Health Commercial |
$1,054.50
|
| Rate for Payer: Humana Commercial |
$943.50
|
| Rate for Payer: Humana KY Medicaid |
$381.73
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$385.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$910.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$819.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$389.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$976.80
|
| Rate for Payer: Ohio Health Group HMO |
$832.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.10
|
| Rate for Payer: PHCS Commercial |
$1,065.60
|
| Rate for Payer: United Healthcare All Payer |
$976.80
|
|
|
ESOPHAGUS NEEDLE ASPIRATION
|
Facility
|
IP
|
$4,568.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
76101735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$593.84 |
| Max. Negotiated Rate |
$4,385.28 |
| Rate for Payer: Aetna Commercial |
$3,517.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,563.04
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cigna Commercial |
$3,791.44
|
| Rate for Payer: First Health Commercial |
$4,339.60
|
| Rate for Payer: Humana Commercial |
$3,882.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,745.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,371.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,370.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,019.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$913.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.08
|
| Rate for Payer: PHCS Commercial |
$4,385.28
|
| Rate for Payer: United Healthcare All Payer |
$4,019.84
|
|
|
ESOPHAGUS NEEDLE ASPIRATION
|
Facility
|
OP
|
$4,568.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
76101735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$593.84 |
| Max. Negotiated Rate |
$4,385.28 |
| Rate for Payer: Aetna Commercial |
$3,517.36
|
| Rate for Payer: Anthem Medicaid |
$1,570.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,563.04
|
| 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 |
$2,284.00
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cigna Commercial |
$3,791.44
|
| Rate for Payer: First Health Commercial |
$4,339.60
|
| Rate for Payer: Humana Commercial |
$3,882.80
|
| Rate for Payer: Humana KY Medicaid |
$1,570.94
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,586.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,745.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,371.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,602.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,019.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$913.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.08
|
| Rate for Payer: PHCS Commercial |
$4,385.28
|
| Rate for Payer: United Healthcare All Payer |
$4,019.84
|
|
|
ESOPHAGUS NEEDLE ASPIRATION
|
Professional
|
Both
|
$4,568.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
76101735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.82 |
| Max. Negotiated Rate |
$4,568.00 |
| Rate for Payer: Aetna Commercial |
$400.54
|
| Rate for Payer: Anthem Medicaid |
$198.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,568.00
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cigna Commercial |
$364.70
|
| Rate for Payer: Healthspan PPO |
$337.78
|
| Rate for Payer: Humana Medicaid |
$198.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$343.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.80
|
| Rate for Payer: Molina Healthcare Passport |
$198.82
|
| Rate for Payer: Multiplan PHCS |
$2,740.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,197.60
|
| Rate for Payer: UHCCP Medicaid |
$1,598.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.81
|
|
|
ESOPHAGUS NEEDLE ASPIRATION(P
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
761P1735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna Commercial |
$400.54
|
| Rate for Payer: Anthem Medicaid |
$198.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$470.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$364.70
|
| Rate for Payer: Healthspan PPO |
$337.78
|
| Rate for Payer: Humana Medicaid |
$198.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$343.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.80
|
| Rate for Payer: Molina Healthcare Passport |
$198.82
|
| Rate for Payer: Multiplan PHCS |
$282.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$329.00
|
| Rate for Payer: UHCCP Medicaid |
$164.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.81
|
|
|
ESOPHAGUS NEEDLE ASPIRATION(T
|
Facility
|
OP
|
$4,098.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
761T1735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$532.74 |
| Max. Negotiated Rate |
$3,934.08 |
| Rate for Payer: Aetna Commercial |
$3,155.46
|
| Rate for Payer: Anthem Medicaid |
$1,409.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.44
|
| 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 |
$2,049.00
|
| Rate for Payer: Cash Price |
$2,049.00
|
| Rate for Payer: Cigna Commercial |
$3,401.34
|
| Rate for Payer: First Health Commercial |
$3,893.10
|
| Rate for Payer: Humana Commercial |
$3,483.30
|
| Rate for Payer: Humana KY Medicaid |
$1,409.30
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,437.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,073.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$819.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$532.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,270.38
|
| Rate for Payer: PHCS Commercial |
$3,934.08
|
| Rate for Payer: United Healthcare All Payer |
$3,606.24
|
|
|
ESOPHAGUS NEEDLE ASPIRATION(T
|
Facility
|
IP
|
$4,098.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
761T1735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$532.74 |
| Max. Negotiated Rate |
$3,934.08 |
| Rate for Payer: Aetna Commercial |
$3,155.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.44
|
| Rate for Payer: Cash Price |
$2,049.00
|
| Rate for Payer: Cigna Commercial |
$3,401.34
|
| Rate for Payer: First Health Commercial |
$3,893.10
|
| Rate for Payer: Humana Commercial |
$3,483.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,073.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$819.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$532.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,270.38
|
| Rate for Payer: PHCS Commercial |
$3,934.08
|
| Rate for Payer: United Healthcare All Payer |
$3,606.24
|
|
|
ESOPHAGUS ULTRASOUND
|
Professional
|
Both
|
$3,824.93
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
76101734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.20 |
| Max. Negotiated Rate |
$3,824.93 |
| Rate for Payer: Aetna Commercial |
$289.92
|
| Rate for Payer: Anthem Medicaid |
$171.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,824.93
|
| Rate for Payer: Cash Price |
$1,912.46
|
| Rate for Payer: Cash Price |
$1,912.46
|
| Rate for Payer: Cigna Commercial |
$260.79
|
| Rate for Payer: Healthspan PPO |
$244.50
|
| Rate for Payer: Humana Medicaid |
$171.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$249.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.62
|
| Rate for Payer: Molina Healthcare Passport |
$171.20
|
| Rate for Payer: Multiplan PHCS |
$2,294.96
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,677.45
|
| Rate for Payer: UHCCP Medicaid |
$1,338.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.91
|
|
|
ESOPHAGUS ULTRASOUND
|
Facility
|
OP
|
$3,824.93
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
76101734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.24 |
| Max. Negotiated Rate |
$3,671.93 |
| Rate for Payer: Aetna Commercial |
$2,945.20
|
| Rate for Payer: Anthem Medicaid |
$1,315.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,983.45
|
| 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 |
$1,912.46
|
| Rate for Payer: Cash Price |
$1,912.46
|
| Rate for Payer: Cigna Commercial |
$3,174.69
|
| Rate for Payer: First Health Commercial |
$3,633.68
|
| Rate for Payer: Humana Commercial |
$3,251.19
|
| Rate for Payer: Humana KY Medicaid |
$1,315.39
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,328.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,136.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,341.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,365.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,868.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$764.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,185.73
|
| Rate for Payer: PHCS Commercial |
$3,671.93
|
| Rate for Payer: United Healthcare All Payer |
$3,365.94
|
|
|
ESOPHAGUS ULTRASOUND
|
Facility
|
IP
|
$3,824.93
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
76101734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.24 |
| Max. Negotiated Rate |
$3,671.93 |
| Rate for Payer: Aetna Commercial |
$2,945.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,983.45
|
| Rate for Payer: Cash Price |
$1,912.46
|
| Rate for Payer: Cigna Commercial |
$3,174.69
|
| Rate for Payer: First Health Commercial |
$3,633.68
|
| Rate for Payer: Humana Commercial |
$3,251.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,136.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,147.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,365.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,868.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$764.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,185.73
|
| Rate for Payer: PHCS Commercial |
$3,671.93
|
| Rate for Payer: United Healthcare All Payer |
$3,365.94
|
|
|
ESOPHAGUS ULTRASOUND(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
761P1734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$289.92
|
| Rate for Payer: Anthem Medicaid |
$171.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$260.79
|
| Rate for Payer: Healthspan PPO |
$244.50
|
| Rate for Payer: Humana Medicaid |
$171.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$249.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.62
|
| Rate for Payer: Molina Healthcare Passport |
$171.20
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.91
|
|
|
ESOPHAGUS ULTRASOUND(T
|
Facility
|
IP
|
$3,474.93
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
761T1734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$451.74 |
| Max. Negotiated Rate |
$3,335.93 |
| Rate for Payer: Aetna Commercial |
$2,675.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,710.45
|
| Rate for Payer: Cash Price |
$1,737.46
|
| Rate for Payer: Cigna Commercial |
$2,884.19
|
| Rate for Payer: First Health Commercial |
$3,301.18
|
| Rate for Payer: Humana Commercial |
$2,953.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,849.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,564.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,042.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,057.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,606.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.23
|
| Rate for Payer: PHCS Commercial |
$3,335.93
|
| Rate for Payer: United Healthcare All Payer |
$3,057.94
|
|
