|
EGD VARICES LIGATION
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
76101740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.79 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Anthem Medicaid |
$307.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$698.10
|
| 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 |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$742.85
|
| Rate for Payer: First Health Commercial |
$850.25
|
| Rate for Payer: Humana Commercial |
$760.75
|
| Rate for Payer: Humana KY Medicaid |
$307.79
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$310.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$660.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$313.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$787.60
|
| Rate for Payer: Ohio Health Group HMO |
$671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$778.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.55
|
| Rate for Payer: PHCS Commercial |
$859.20
|
| Rate for Payer: United Healthcare All Payer |
$787.60
|
|
|
EGD VARICES LIGATION
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
76101740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.73 |
| Max. Negotiated Rate |
$537.00 |
| Rate for Payer: Aetna Commercial |
$453.26
|
| Rate for Payer: Ambetter Exchange |
$227.73
|
| Rate for Payer: Anthem Medicaid |
$237.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$227.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$227.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$273.28
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$406.41
|
| Rate for Payer: Healthspan PPO |
$382.24
|
| Rate for Payer: Humana Medicaid |
$237.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$227.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.47
|
| Rate for Payer: Molina Healthcare Passport |
$237.72
|
| Rate for Payer: Multiplan PHCS |
$537.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$296.05
|
| Rate for Payer: UHCCP Medicaid |
$313.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$227.73
|
|
|
EGD VARICES LIGATION
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
76101740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.50 |
| Max. Negotiated Rate |
$859.20 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$698.10
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$742.85
|
| Rate for Payer: First Health Commercial |
$850.25
|
| Rate for Payer: Humana Commercial |
$760.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$660.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$787.60
|
| Rate for Payer: Ohio Health Group HMO |
$671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$778.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.55
|
| Rate for Payer: PHCS Commercial |
$859.20
|
| Rate for Payer: United Healthcare All Payer |
$787.60
|
|
|
EGD VARICES LIGATION(P
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
761P1740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.73 |
| Max. Negotiated Rate |
$537.00 |
| Rate for Payer: Aetna Commercial |
$453.26
|
| Rate for Payer: Ambetter Exchange |
$227.73
|
| Rate for Payer: Anthem Medicaid |
$237.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$227.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$227.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$273.28
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$406.41
|
| Rate for Payer: Healthspan PPO |
$382.24
|
| Rate for Payer: Humana Medicaid |
$237.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$227.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.47
|
| Rate for Payer: Molina Healthcare Passport |
$237.72
|
| Rate for Payer: Multiplan PHCS |
$537.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$296.05
|
| Rate for Payer: UHCCP Medicaid |
$313.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$227.73
|
|
|
EGD WITH GASTRORRHAPHY
|
Professional
|
Both
|
$2,874.65
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
76101801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,012.26 |
| Rate for Payer: Anthem Medicaid |
$100.00
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$100.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.00
|
| Rate for Payer: Molina Healthcare Passport |
$100.00
|
| Rate for Payer: Multiplan PHCS |
$1,724.79
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,012.26
|
| Rate for Payer: UHCCP Medicaid |
$1,006.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.00
|
|
|
EGD WITH GASTRORRHAPHY
|
Facility
|
IP
|
$2,874.65
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
76101801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$862.39 |
| Max. Negotiated Rate |
$2,759.66 |
| Rate for Payer: Aetna Commercial |
$2,213.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,242.23
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Cigna Commercial |
$2,385.96
|
| Rate for Payer: First Health Commercial |
$2,730.92
|
| Rate for Payer: Humana Commercial |
$2,443.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,357.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,121.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$862.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,155.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,299.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,500.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,983.51
|
| Rate for Payer: PHCS Commercial |
$2,759.66
|
| Rate for Payer: United Healthcare All Payer |
$2,529.69
|
|
|
EGD WITH GASTRORRHAPHY
|
Facility
|
OP
|
$2,874.65
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
76101801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.29 |
| Max. Negotiated Rate |
$2,759.66 |
| Rate for Payer: Aetna Commercial |
$2,213.48
|
| Rate for Payer: Anthem Medicaid |
$988.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,242.23
|
| 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 |
$1,437.33
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Cigna Commercial |
$2,385.96
|
| Rate for Payer: First Health Commercial |
$2,730.92
|
| Rate for Payer: Humana Commercial |
$2,443.45
|
| Rate for Payer: Humana KY Medicaid |
$988.59
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$998.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,357.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,121.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,008.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,155.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,299.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,500.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,983.51
|
| Rate for Payer: PHCS Commercial |
$2,759.66
|
| Rate for Payer: United Healthcare All Payer |
$2,529.69
|
|
|
EGD WITH GASTRORRHAPHY(T
|
Facility
|
OP
|
$2,874.65
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
761T1801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.29 |
| Max. Negotiated Rate |
$2,759.66 |
| Rate for Payer: Aetna Commercial |
$2,213.48
|
| Rate for Payer: Anthem Medicaid |
$988.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,242.23
|
| 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 |
$1,437.33
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Cigna Commercial |
$2,385.96
|
| Rate for Payer: First Health Commercial |
$2,730.92
|
| Rate for Payer: Humana Commercial |
$2,443.45
|
| Rate for Payer: Humana KY Medicaid |
$988.59
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$998.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,357.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,121.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,008.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,155.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,299.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,500.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,983.51
|
| Rate for Payer: PHCS Commercial |
$2,759.66
|
| Rate for Payer: United Healthcare All Payer |
$2,529.69
|
|
|
EGD WITH GASTRORRHAPHY(T
|
Facility
|
IP
|
$2,874.65
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
761T1801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$862.39 |
| Max. Negotiated Rate |
$2,759.66 |
| Rate for Payer: Aetna Commercial |
$2,213.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,242.23
|
| Rate for Payer: Cash Price |
$1,437.33
|
| Rate for Payer: Cigna Commercial |
$2,385.96
|
| Rate for Payer: First Health Commercial |
$2,730.92
|
| Rate for Payer: Humana Commercial |
$2,443.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,357.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,121.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$862.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,155.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,299.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,500.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,983.51
|
| Rate for Payer: PHCS Commercial |
$2,759.66
|
| Rate for Payer: United Healthcare All Payer |
$2,529.69
|
|
|
EGD W/THRML TXMNT GERD
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 43257
|
| Hospital Charge Code |
76101750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
EGD W/THRML TXMNT GERD
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 43257
|
| Hospital Charge Code |
76101750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.53 |
| Max. Negotiated Rate |
$4,921.43 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,515.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,921.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,745.67
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Humana KY Medicaid |
$223.53
|
| Rate for Payer: Humana Medicare Advantage |
$3,515.31
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,218.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
EGD W/THRML TXMNT GERD
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 43257
|
| Hospital Charge Code |
76101750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.36 |
| Max. Negotiated Rate |
$476.96 |
| Rate for Payer: Aetna Commercial |
$476.96
|
| Rate for Payer: Ambetter Exchange |
$216.36
|
| Rate for Payer: Anthem Medicaid |
$228.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$216.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$216.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$259.63
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$431.75
|
| Rate for Payer: Healthspan PPO |
$402.23
|
| Rate for Payer: Humana Medicaid |
$228.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$216.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.22
|
| Rate for Payer: Molina Healthcare Passport |
$228.65
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$281.27
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$216.36
|
|
|
EGD W/THRML TXMNT GERD(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 43257
|
| Hospital Charge Code |
761P1750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.36 |
| Max. Negotiated Rate |
$476.96 |
| Rate for Payer: Aetna Commercial |
$476.96
|
| Rate for Payer: Ambetter Exchange |
$216.36
|
| Rate for Payer: Anthem Medicaid |
$228.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$216.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$216.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$259.63
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$431.75
|
| Rate for Payer: Healthspan PPO |
$402.23
|
| Rate for Payer: Humana Medicaid |
$228.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$216.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.22
|
| Rate for Payer: Molina Healthcare Passport |
$228.65
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$281.27
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$216.36
|
|
|
EGG WHITE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
EGG WHITE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
EKG CANCER CENTER (T
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
730T0007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem Medicaid |
$83.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Humana KY Medicaid |
$83.22
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$84.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
EKG CANCER CENTER (T
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
730T0007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.76
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
EKG INTERPRET & REPORT PREVE
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS G0405
|
| Hospital Charge Code |
73000102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Ambetter Exchange |
$7.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.12
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.60
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.88
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.60
|
|
|
EKG INT/RE CANCER CENTER (P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 93010
|
| Hospital Charge Code |
730P0007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Ambetter Exchange |
$7.60
|
| Rate for Payer: Anthem Medicaid |
$9.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.12
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$13.30
|
| Rate for Payer: Healthspan PPO |
$14.09
|
| Rate for Payer: Humana Medicaid |
$9.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.71
|
| Rate for Payer: Molina Healthcare Passport |
$9.52
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.88
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.60
|
|
|
EKG REG CANCER CENTER
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$33.91
|
| Rate for Payer: Ambetter Exchange |
$13.24
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.89
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$38.05
|
| Rate for Payer: Healthspan PPO |
$31.87
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$169.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.21
|
| Rate for Payer: UHCCP Medicaid |
$98.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.24
|
|
|
EKG REG CANCER CENTER
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$219.96
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$234.06
|
| Rate for Payer: First Health Commercial |
$267.90
|
| Rate for Payer: Humana Commercial |
$239.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$231.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$248.16
|
| Rate for Payer: Ohio Health Group HMO |
$211.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.58
|
| Rate for Payer: PHCS Commercial |
$270.72
|
| Rate for Payer: United Healthcare All Payer |
$248.16
|
|
|
EKG REG CANCER CENTER
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000007
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Anthem Medicaid |
$96.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$219.96
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$234.06
|
| Rate for Payer: First Health Commercial |
$267.90
|
| Rate for Payer: Humana Commercial |
$239.70
|
| Rate for Payer: Humana KY Medicaid |
$96.98
|
| Rate for Payer: Kentucky WC Medicaid |
$97.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$231.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$248.16
|
| Rate for Payer: Ohio Health Group HMO |
$211.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.58
|
| Rate for Payer: PHCS Commercial |
$270.72
|
| Rate for Payer: United Healthcare All Payer |
$248.16
|
|
|
EKG REGULAR
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$288.96 |
| Rate for Payer: Aetna Commercial |
$231.77
|
| Rate for Payer: Anthem Medicaid |
$103.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.78
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cigna Commercial |
$249.83
|
| Rate for Payer: First Health Commercial |
$285.95
|
| Rate for Payer: Humana Commercial |
$255.85
|
| Rate for Payer: Humana KY Medicaid |
$103.51
|
| Rate for Payer: Kentucky WC Medicaid |
$104.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.88
|
| Rate for Payer: Ohio Health Group HMO |
$225.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.69
|
| Rate for Payer: PHCS Commercial |
$288.96
|
| Rate for Payer: United Healthcare All Payer |
$264.88
|
|
|
EKG REGULAR
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$180.60 |
| Rate for Payer: Aetna Commercial |
$33.91
|
| Rate for Payer: Ambetter Exchange |
$13.24
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.89
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cigna Commercial |
$38.05
|
| Rate for Payer: Healthspan PPO |
$31.87
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$180.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.21
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.24
|
|
|
EKG REGULAR
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$288.96 |
| Rate for Payer: Aetna Commercial |
$231.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.78
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cigna Commercial |
$249.83
|
| Rate for Payer: First Health Commercial |
$285.95
|
| Rate for Payer: Humana Commercial |
$255.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.88
|
| Rate for Payer: Ohio Health Group HMO |
$225.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.69
|
| Rate for Payer: PHCS Commercial |
$288.96
|
| Rate for Payer: United Healthcare All Payer |
$264.88
|
|
