|
ESOPHAGOMYOTOMY ABDOMINAL(P
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 43330
|
| Hospital Charge Code |
761P1772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$1,916.20 |
| Rate for Payer: Aetna Commercial |
$1,916.20
|
| Rate for Payer: Ambetter Exchange |
$1,274.61
|
| Rate for Payer: Anthem Medicaid |
$781.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,274.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,274.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,529.53
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,786.91
|
| Rate for Payer: Healthspan PPO |
$1,615.96
|
| Rate for Payer: Humana Medicaid |
$781.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,693.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,274.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$797.13
|
| Rate for Payer: Molina Healthcare Passport |
$781.50
|
| Rate for Payer: Multiplan PHCS |
$918.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,656.99
|
| Rate for Payer: UHCCP Medicaid |
$535.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$789.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,274.61
|
|
|
ESOPHAGOSCOPY
|
Professional
|
Both
|
$3,234.13
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
76101726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.12 |
| Max. Negotiated Rate |
$1,940.48 |
| Rate for Payer: Aetna Commercial |
$155.63
|
| Rate for Payer: Ambetter Exchange |
$82.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.50
|
| Rate for Payer: Anthem Medicaid |
$107.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$82.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$82.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.54
|
| Rate for Payer: Cash Price |
$1,617.07
|
| Rate for Payer: Cash Price |
$1,617.07
|
| Rate for Payer: Cigna Commercial |
$149.16
|
| Rate for Payer: Healthspan PPO |
$255.38
|
| Rate for Payer: Humana Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$82.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.84
|
| Rate for Payer: Molina Healthcare Passport |
$107.69
|
| Rate for Payer: Multiplan PHCS |
$1,940.48
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$106.76
|
| Rate for Payer: UHCCP Medicaid |
$91.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$82.12
|
|
|
ESOPHAGOSCOPY
|
Facility
|
OP
|
$3,234.13
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
76101726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.29 |
| Max. Negotiated Rate |
$3,104.76 |
| Rate for Payer: Aetna Commercial |
$2,490.28
|
| Rate for Payer: Anthem Medicaid |
$1,112.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,522.62
|
| 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 |
$1,617.07
|
| Rate for Payer: Cash Price |
$1,617.07
|
| Rate for Payer: Cigna Commercial |
$2,684.33
|
| Rate for Payer: First Health Commercial |
$3,072.42
|
| Rate for Payer: Humana Commercial |
$2,749.01
|
| Rate for Payer: Humana KY Medicaid |
$1,112.22
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,123.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,651.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,386.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,134.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,846.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,425.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,587.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,813.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,231.55
|
| Rate for Payer: PHCS Commercial |
$3,104.76
|
| Rate for Payer: United Healthcare All Payer |
$2,846.03
|
|
|
ESOPHAGOSCOPY
|
Facility
|
OP
|
$3,323.75
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
76101728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,143.04 |
| Max. Negotiated Rate |
$3,190.80 |
| Rate for Payer: Aetna Commercial |
$2,559.29
|
| Rate for Payer: Anthem Medicaid |
$1,143.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,592.53
|
| 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 |
$1,661.88
|
| Rate for Payer: Cash Price |
$1,661.88
|
| Rate for Payer: Cigna Commercial |
$2,758.71
|
| Rate for Payer: First Health Commercial |
$3,157.56
|
| Rate for Payer: Humana Commercial |
$2,825.19
|
| Rate for Payer: Humana KY Medicaid |
$1,143.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,154.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,725.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,452.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,165.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,924.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,492.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,659.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,891.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.39
|
| Rate for Payer: PHCS Commercial |
$3,190.80
|
| Rate for Payer: United Healthcare All Payer |
$2,924.90
|
|
|
ESOPHAGOSCOPY
|
Professional
|
Both
|
$3,323.75
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
76101728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.99 |
| Max. Negotiated Rate |
$1,994.25 |
| Rate for Payer: Aetna Commercial |
$173.30
|
| Rate for Payer: Ambetter Exchange |
$95.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.44
|
| Rate for Payer: Anthem Medicaid |
$127.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.19
|
| Rate for Payer: Cash Price |
$1,661.88
|
| Rate for Payer: Cash Price |
$1,661.88
|
| Rate for Payer: Cigna Commercial |
$161.26
|
| Rate for Payer: Healthspan PPO |
$334.37
|
| Rate for Payer: Humana Medicaid |
$127.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.18
|
| Rate for Payer: Molina Healthcare Passport |
$127.63
|
| Rate for Payer: Multiplan PHCS |
$1,994.25
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$124.79
|
| Rate for Payer: UHCCP Medicaid |
$102.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.99
|
|
|
ESOPHAGOSCOPY
|
Facility
|
IP
|
$3,323.75
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
76101728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$997.12 |
| Max. Negotiated Rate |
$3,190.80 |
| Rate for Payer: Aetna Commercial |
$2,559.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,592.53
|
| Rate for Payer: Cash Price |
$1,661.88
|
| Rate for Payer: Cigna Commercial |
$2,758.71
|
| Rate for Payer: First Health Commercial |
$3,157.56
|
| Rate for Payer: Humana Commercial |
$2,825.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,725.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,452.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$997.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,924.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,492.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,659.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,891.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.39
|
| Rate for Payer: PHCS Commercial |
$3,190.80
|
| Rate for Payer: United Healthcare All Payer |
$2,924.90
|
|
|
ESOPHAGOSCOPY
|
Facility
|
IP
|
$3,234.13
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
76101726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$970.24 |
| Max. Negotiated Rate |
$3,104.76 |
| Rate for Payer: Aetna Commercial |
$2,490.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,522.62
|
| Rate for Payer: Cash Price |
$1,617.07
|
| Rate for Payer: Cigna Commercial |
$2,684.33
|
| Rate for Payer: First Health Commercial |
$3,072.42
|
| Rate for Payer: Humana Commercial |
$2,749.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,651.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,386.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$970.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,846.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,425.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,587.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,813.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,231.55
|
| Rate for Payer: PHCS Commercial |
$3,104.76
|
| Rate for Payer: United Healthcare All Payer |
$2,846.03
|
|
|
ESOPHAGOSCOPY BALLOON <30MM
|
Facility
|
IP
|
$3,955.40
|
|
|
Service Code
|
HCPCS 43220
|
| Hospital Charge Code |
76101732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,186.62 |
| Max. Negotiated Rate |
$3,797.18 |
| Rate for Payer: Aetna Commercial |
$3,045.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,085.21
|
| Rate for Payer: Cash Price |
$1,977.70
|
| Rate for Payer: Cigna Commercial |
$3,282.98
|
| Rate for Payer: First Health Commercial |
$3,757.63
|
| Rate for Payer: Humana Commercial |
$3,362.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,243.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,919.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,186.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,480.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,966.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,164.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,441.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,729.23
|
| Rate for Payer: PHCS Commercial |
$3,797.18
|
| Rate for Payer: United Healthcare All Payer |
$3,480.75
|
|
|
ESOPHAGOSCOPY BALLOON <30MM
|
Facility
|
OP
|
$3,955.40
|
|
|
Service Code
|
HCPCS 43220
|
| Hospital Charge Code |
76101732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,360.26 |
| Max. Negotiated Rate |
$3,797.18 |
| Rate for Payer: Aetna Commercial |
$3,045.66
|
| Rate for Payer: Anthem Medicaid |
$1,360.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,085.21
|
| 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 |
$1,977.70
|
| Rate for Payer: Cash Price |
$1,977.70
|
| Rate for Payer: Cigna Commercial |
$3,282.98
|
| Rate for Payer: First Health Commercial |
$3,757.63
|
| Rate for Payer: Humana Commercial |
$3,362.09
|
| Rate for Payer: Humana KY Medicaid |
$1,360.26
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,374.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,243.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,919.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,387.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,480.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,966.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,164.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,441.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,729.23
|
| Rate for Payer: PHCS Commercial |
$3,797.18
|
| Rate for Payer: United Healthcare All Payer |
$3,480.75
|
|
|
ESOPHAGOSCOPY BALLOON <30MM
|
Professional
|
Both
|
$3,955.40
|
|
|
Service Code
|
HCPCS 43220
|
| Hospital Charge Code |
76101732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.36 |
| Max. Negotiated Rate |
$2,373.24 |
| Rate for Payer: Aetna Commercial |
$192.75
|
| Rate for Payer: Ambetter Exchange |
$110.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.36
|
| Rate for Payer: Anthem Medicaid |
$140.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.06
|
| Rate for Payer: Cash Price |
$1,977.70
|
| Rate for Payer: Cash Price |
$1,977.70
|
| Rate for Payer: Cigna Commercial |
$176.93
|
| Rate for Payer: Healthspan PPO |
$162.55
|
| Rate for Payer: Humana Medicaid |
$140.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$165.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$110.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$142.86
|
| Rate for Payer: Molina Healthcare Passport |
$140.06
|
| Rate for Payer: Multiplan PHCS |
$2,373.24
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.14
|
| Rate for Payer: UHCCP Medicaid |
$113.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.88
|
|
|
ESOPHAGOSCOPY BALLOON <30MM(P
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 43220
|
| Hospital Charge Code |
761P1732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.36 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$192.75
|
| Rate for Payer: Ambetter Exchange |
$110.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.36
|
| Rate for Payer: Anthem Medicaid |
$140.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.06
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$176.93
|
| Rate for Payer: Healthspan PPO |
$162.55
|
| Rate for Payer: Humana Medicaid |
$140.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$165.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$110.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$142.86
|
| Rate for Payer: Molina Healthcare Passport |
$140.06
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.14
|
| Rate for Payer: UHCCP Medicaid |
$113.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.88
|
|
|
ESOPHAGOSCOPY BALLOON <30MM(T
|
Facility
|
IP
|
$3,130.40
|
|
|
Service Code
|
HCPCS 43220
|
| Hospital Charge Code |
761T1732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$939.12 |
| Max. Negotiated Rate |
$3,005.18 |
| Rate for Payer: Aetna Commercial |
$2,410.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.71
|
| Rate for Payer: Cash Price |
$1,565.20
|
| Rate for Payer: Cigna Commercial |
$2,598.23
|
| Rate for Payer: First Health Commercial |
$2,973.88
|
| Rate for Payer: Humana Commercial |
$2,660.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,310.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,504.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.98
|
| Rate for Payer: PHCS Commercial |
$3,005.18
|
| Rate for Payer: United Healthcare All Payer |
$2,754.75
|
|
|
ESOPHAGOSCOPY BALLOON <30MM(T
|
Facility
|
OP
|
$3,130.40
|
|
|
Service Code
|
HCPCS 43220
|
| Hospital Charge Code |
761T1732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,076.54 |
| Max. Negotiated Rate |
$3,005.18 |
| Rate for Payer: Aetna Commercial |
$2,410.41
|
| Rate for Payer: Anthem Medicaid |
$1,076.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.71
|
| 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 |
$1,565.20
|
| Rate for Payer: Cash Price |
$1,565.20
|
| Rate for Payer: Cigna Commercial |
$2,598.23
|
| Rate for Payer: First Health Commercial |
$2,973.88
|
| Rate for Payer: Humana Commercial |
$2,660.84
|
| Rate for Payer: Humana KY Medicaid |
$1,076.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,087.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,310.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,098.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,504.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.98
|
| Rate for Payer: PHCS Commercial |
$3,005.18
|
| Rate for Payer: United Healthcare All Payer |
$2,754.75
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$4,921.43
|
|
|
Service Code
|
CPT 43229
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,515.31 |
| Max. Negotiated Rate |
$4,921.43 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,515.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,921.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,745.67
|
| Rate for Payer: Humana Medicare Advantage |
$3,515.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,218.37
|
|
|
ESOPHAGOSCOPY LESION ABLATE
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 43229
|
| Hospital Charge Code |
76101733
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.90 |
| Max. Negotiated Rate |
$938.67 |
| Rate for Payer: Ambetter Exchange |
$183.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$160.90
|
| Rate for Payer: Anthem Medicaid |
$545.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$183.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$183.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$219.95
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$344.54
|
| Rate for Payer: Healthspan PPO |
$938.67
|
| Rate for Payer: Humana Medicaid |
$545.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$270.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$183.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$556.27
|
| Rate for Payer: Molina Healthcare Passport |
$545.36
|
| Rate for Payer: Multiplan PHCS |
$243.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.28
|
| Rate for Payer: UHCCP Medicaid |
$168.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$550.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$183.29
|
|
|
ESOPHAGOSCOPY LESION ABLATE
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS 43229
|
| Hospital Charge Code |
76101733
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$336.15
|
| Rate for Payer: First Health Commercial |
$384.75
|
| Rate for Payer: Humana Commercial |
$344.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
| Rate for Payer: Ohio Health Group HMO |
$303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.45
|
| Rate for Payer: PHCS Commercial |
$388.80
|
| Rate for Payer: United Healthcare All Payer |
$356.40
|
|
|
ESOPHAGOSCOPY LESION ABLATE
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS 43229
|
| Hospital Charge Code |
76101733
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.28 |
| Max. Negotiated Rate |
$4,921.43 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: Anthem Medicaid |
$139.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,515.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
| 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 |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$336.15
|
| Rate for Payer: First Health Commercial |
$384.75
|
| Rate for Payer: Humana Commercial |
$344.25
|
| Rate for Payer: Humana KY Medicaid |
$139.28
|
| Rate for Payer: Humana Medicare Advantage |
$3,515.31
|
| Rate for Payer: Kentucky WC Medicaid |
$140.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,218.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$142.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
| Rate for Payer: Ohio Health Group HMO |
$303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.45
|
| Rate for Payer: PHCS Commercial |
$388.80
|
| Rate for Payer: United Healthcare All Payer |
$356.40
|
|
|
ESOPHAGOSCOPY LESION ABLATE(P
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 43229
|
| Hospital Charge Code |
761P1733
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.90 |
| Max. Negotiated Rate |
$938.67 |
| Rate for Payer: Ambetter Exchange |
$183.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$160.90
|
| Rate for Payer: Anthem Medicaid |
$545.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$183.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$183.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$219.95
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$344.54
|
| Rate for Payer: Healthspan PPO |
$938.67
|
| Rate for Payer: Humana Medicaid |
$545.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$270.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$183.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$556.27
|
| Rate for Payer: Molina Healthcare Passport |
$545.36
|
| Rate for Payer: Multiplan PHCS |
$243.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.28
|
| Rate for Payer: UHCCP Medicaid |
$168.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$550.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$183.29
|
|
|
ESOPHAGOSCOPY(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
761P1726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.12 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$155.63
|
| Rate for Payer: Ambetter Exchange |
$82.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.50
|
| Rate for Payer: Anthem Medicaid |
$107.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$82.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$82.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.54
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$149.16
|
| Rate for Payer: Healthspan PPO |
$255.38
|
| Rate for Payer: Humana Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$82.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.84
|
| Rate for Payer: Molina Healthcare Passport |
$107.69
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$106.76
|
| Rate for Payer: UHCCP Medicaid |
$91.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$82.12
|
|
|
ESOPHAGOSCOPY(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
761P1728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.99 |
| Max. Negotiated Rate |
$334.37 |
| Rate for Payer: Aetna Commercial |
$173.30
|
| Rate for Payer: Ambetter Exchange |
$95.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.44
|
| Rate for Payer: Anthem Medicaid |
$127.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.19
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$161.26
|
| Rate for Payer: Healthspan PPO |
$334.37
|
| Rate for Payer: Humana Medicaid |
$127.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.18
|
| Rate for Payer: Molina Healthcare Passport |
$127.63
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$124.79
|
| Rate for Payer: UHCCP Medicaid |
$102.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.99
|
|
|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Facility
|
IP
|
$4,152.00
|
|
|
Service Code
|
HCPCS 43215
|
| Hospital Charge Code |
76101730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,245.60 |
| Max. Negotiated Rate |
$3,985.92 |
| Rate for Payer: Aetna Commercial |
$3,197.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,238.56
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$3,446.16
|
| Rate for Payer: First Health Commercial |
$3,944.40
|
| Rate for Payer: Humana Commercial |
$3,529.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,404.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,064.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,245.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,653.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.88
|
| Rate for Payer: PHCS Commercial |
$3,985.92
|
| Rate for Payer: United Healthcare All Payer |
$3,653.76
|
|
|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 43215
|
| Hospital Charge Code |
761P1730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.01 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$234.81
|
| Rate for Payer: Ambetter Exchange |
$132.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$132.01
|
| Rate for Payer: Anthem Medicaid |
$176.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$132.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$132.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$159.50
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$217.90
|
| Rate for Payer: Healthspan PPO |
$198.02
|
| Rate for Payer: Humana Medicaid |
$176.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$132.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.33
|
| Rate for Payer: Molina Healthcare Passport |
$176.79
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$172.80
|
| Rate for Payer: UHCCP Medicaid |
$138.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$132.92
|
|
|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Facility
|
OP
|
$3,302.00
|
|
|
Service Code
|
HCPCS 43215
|
| Hospital Charge Code |
761T1730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,135.56 |
| Max. Negotiated Rate |
$3,169.92 |
| Rate for Payer: Aetna Commercial |
$2,542.54
|
| Rate for Payer: Anthem Medicaid |
$1,135.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.56
|
| 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 |
$1,651.00
|
| Rate for Payer: Cash Price |
$1,651.00
|
| Rate for Payer: Cigna Commercial |
$2,740.66
|
| Rate for Payer: First Health Commercial |
$3,136.90
|
| Rate for Payer: Humana Commercial |
$2,806.70
|
| Rate for Payer: Humana KY Medicaid |
$1,135.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,147.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,707.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,436.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,158.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,905.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,476.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,641.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,872.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,278.38
|
| Rate for Payer: PHCS Commercial |
$3,169.92
|
| Rate for Payer: United Healthcare All Payer |
$2,905.76
|
|
|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Facility
|
OP
|
$4,152.00
|
|
|
Service Code
|
HCPCS 43215
|
| Hospital Charge Code |
76101730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,427.87 |
| Max. Negotiated Rate |
$3,985.92 |
| Rate for Payer: Aetna Commercial |
$3,197.04
|
| Rate for Payer: Anthem Medicaid |
$1,427.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,238.56
|
| 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 |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$3,446.16
|
| Rate for Payer: First Health Commercial |
$3,944.40
|
| Rate for Payer: Humana Commercial |
$3,529.20
|
| Rate for Payer: Humana KY Medicaid |
$1,427.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,442.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,404.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,064.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,456.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,653.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.88
|
| Rate for Payer: PHCS Commercial |
$3,985.92
|
| Rate for Payer: United Healthcare All Payer |
$3,653.76
|
|
|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Facility
|
IP
|
$3,302.00
|
|
|
Service Code
|
HCPCS 43215
|
| Hospital Charge Code |
761T1730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$990.60 |
| Max. Negotiated Rate |
$3,169.92 |
| Rate for Payer: Aetna Commercial |
$2,542.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.56
|
| Rate for Payer: Cash Price |
$1,651.00
|
| Rate for Payer: Cigna Commercial |
$2,740.66
|
| Rate for Payer: First Health Commercial |
$3,136.90
|
| Rate for Payer: Humana Commercial |
$2,806.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,707.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,436.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,905.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,476.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,641.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,872.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,278.38
|
| Rate for Payer: PHCS Commercial |
$3,169.92
|
| Rate for Payer: United Healthcare All Payer |
$2,905.76
|
|
