|
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 |
$767.24 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem Medicaid |
$767.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| 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 |
$1,752.78
|
| 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 |
$2,103.34
|
| 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 |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
EGD GUIDE WIRE INSERTION
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
76101744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.78 |
| Max. Negotiated Rate |
$288.68 |
| Rate for Payer: Aetna Commercial |
$288.68
|
| Rate for Payer: Ambetter Exchange |
$154.78
|
| 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 Individual/Medicaid |
$154.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$154.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.74
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$154.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.78
|
| 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 |
$201.21
|
| Rate for Payer: UHCCP Medicaid |
$170.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$154.78
|
|
|
EGD GUIDE WIRE INSERTION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
76101744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| 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 |
$866.29
|
| 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 |
$1,039.55
|
| 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 |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
EGD GUIDE WIRE INSERTION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
76101744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.00 |
| 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 |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| 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 |
$154.78 |
| Max. Negotiated Rate |
$288.68 |
| Rate for Payer: Aetna Commercial |
$288.68
|
| Rate for Payer: Ambetter Exchange |
$154.78
|
| 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 Individual/Medicaid |
$154.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$154.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.74
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$154.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.78
|
| 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 |
$201.21
|
| Rate for Payer: UHCCP Medicaid |
$170.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$154.78
|
|
|
EGD LESION ABLATION
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 43270
|
| Hospital Charge Code |
76101757
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.02 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem Medicaid |
$337.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| 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 |
$1,752.78
|
| 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 |
$2,103.34
|
| 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 |
$784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.20
|
| 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 |
$294.00 |
| 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 |
$784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.20
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
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 |
$939.05 |
| Rate for Payer: Ambetter Exchange |
$209.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.23
|
| Rate for Payer: Anthem Medicaid |
$546.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$209.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$209.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$251.38
|
| 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 |
$546.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$318.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$209.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$557.10
|
| Rate for Payer: Molina Healthcare Passport |
$546.18
|
| Rate for Payer: Multiplan PHCS |
$588.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$272.32
|
| Rate for Payer: UHCCP Medicaid |
$198.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$551.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$209.48
|
|
|
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 |
$939.05 |
| Rate for Payer: Ambetter Exchange |
$209.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.23
|
| Rate for Payer: Anthem Medicaid |
$546.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$209.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$209.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$251.38
|
| 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 |
$546.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$318.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$209.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$557.10
|
| Rate for Payer: Molina Healthcare Passport |
$546.18
|
| Rate for Payer: Multiplan PHCS |
$588.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$272.32
|
| Rate for Payer: UHCCP Medicaid |
$198.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$551.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$209.48
|
|
|
EGD PLACE GASTROSTOMY TUBE
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
76101742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| 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 |
$187.46 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$383.86
|
| Rate for Payer: Ambetter Exchange |
$187.46
|
| Rate for Payer: Anthem Medicaid |
$288.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.95
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$187.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.46
|
| 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 |
$243.70
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.46
|
|
|
EGD PLACE GASTROSTOMY TUBE
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
76101742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| 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 |
$1,752.78
|
| 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 |
$2,103.34
|
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
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 |
$187.46 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$383.86
|
| Rate for Payer: Ambetter Exchange |
$187.46
|
| Rate for Payer: Anthem Medicaid |
$288.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.95
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$187.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.46
|
| 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 |
$243.70
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.46
|
|
|
EGD REMOVE FOREIGN BODY
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
76101743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.65 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$306.41
|
| Rate for Payer: Ambetter Exchange |
$164.65
|
| 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 Individual/Medicaid |
$164.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$164.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$197.58
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$164.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.65
|
| 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 |
$214.04
|
| Rate for Payer: UHCCP Medicaid |
$180.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$164.65
|
|
|
EGD REMOVE FOREIGN BODY
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
76101743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
EGD REMOVE FOREIGN BODY
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
76101743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| 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 |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| 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 |
$1,039.55
|
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| 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 |
$164.65 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$306.41
|
| Rate for Payer: Ambetter Exchange |
$164.65
|
| 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 Individual/Medicaid |
$164.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$164.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$197.58
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$164.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.65
|
| 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 |
$214.04
|
| Rate for Payer: UHCCP Medicaid |
$180.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$164.65
|
|
|
EGD REMOVE LESION SNARE
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
76101747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.67 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem Medicaid |
$314.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| 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 |
$1,752.78
|
| 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 |
$2,103.34
|
| 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 |
$732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.35
|
| 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 |
$274.50 |
| 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 |
$732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.35
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
EGD REMOVE LESION SNARE
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
76101747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna Commercial |
$333.23
|
| Rate for Payer: Ambetter Exchange |
$182.60
|
| 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 Individual/Medicaid |
$182.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$182.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$219.12
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$182.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$182.60
|
| 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 |
$237.38
|
| Rate for Payer: UHCCP Medicaid |
$196.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$182.60
|
|
|
EGD REMOVE LESION SNARE(P
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
761P1747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna Commercial |
$333.23
|
| Rate for Payer: Ambetter Exchange |
$182.60
|
| 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 Individual/Medicaid |
$182.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$182.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$219.12
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$182.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$182.60
|
| 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 |
$237.38
|
| Rate for Payer: UHCCP Medicaid |
$196.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$182.60
|
|
|
EGD TUBE/CATH INSERTION
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 43241
|
| Hospital Charge Code |
76101739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.12 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$237.80
|
| Rate for Payer: Ambetter Exchange |
$133.12
|
| Rate for Payer: Anthem Medicaid |
$174.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$159.74
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$133.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.12
|
| 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 |
$173.06
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.12
|
|
|
EGD TUBE/CATH INSERTION
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 43241
|
| Hospital Charge Code |
76101739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| 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 |
$292.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| 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 |
$2,103.34
|
| 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 |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| 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 |
$255.00 |
| 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 |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
EGD TUBE/CATH INSERTION(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 43241
|
| Hospital Charge Code |
761P1739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.12 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$237.80
|
| Rate for Payer: Ambetter Exchange |
$133.12
|
| Rate for Payer: Anthem Medicaid |
$174.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$159.74
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$133.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.12
|
| 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 |
$173.06
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.12
|
|
