|
ESOPHAGOSCOPY - REMOVE FOR.BOD
|
Professional
|
Both
|
$4,152.00
|
|
|
Service Code
|
HCPCS 43215
|
| Hospital Charge Code |
76101730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.01 |
| Max. Negotiated Rate |
$2,491.20 |
| 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 |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$217.90
|
| Rate for Payer: Healthspan PPO |
$198.02
|
| Rate for Payer: Humana Medicaid |
$176.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.12
|
| Rate for Payer: 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 |
$2,491.20
|
| 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 RIGID BALLOON
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 43195
|
| Hospital Charge Code |
76101725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$297.01 |
| Rate for Payer: Ambetter Exchange |
$175.42
|
| Rate for Payer: Anthem Medicaid |
$144.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna Commercial |
$297.01
|
| Rate for Payer: Healthspan PPO |
$245.39
|
| Rate for Payer: Humana Medicaid |
$144.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$147.37
|
| Rate for Payer: Molina Healthcare Passport |
$144.48
|
| Rate for Payer: Multiplan PHCS |
$231.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.05
|
| Rate for Payer: UHCCP Medicaid |
$134.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.42
|
|
|
ESOPHAGOSCOPY RIGID BALLOON
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS 43195
|
| Hospital Charge Code |
76101725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$369.60 |
| Rate for Payer: Aetna Commercial |
$296.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$300.30
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna Commercial |
$319.55
|
| Rate for Payer: First Health Commercial |
$365.75
|
| Rate for Payer: Humana Commercial |
$327.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$315.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$338.80
|
| Rate for Payer: Ohio Health Group HMO |
$288.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$265.65
|
| Rate for Payer: PHCS Commercial |
$369.60
|
| Rate for Payer: United Healthcare All Payer |
$338.80
|
|
|
ESOPHAGOSCOPY RIGID BALLOON
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS 43195
|
| Hospital Charge Code |
76101725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.40 |
| Max. Negotiated Rate |
$4,921.43 |
| Rate for Payer: Aetna Commercial |
$296.45
|
| Rate for Payer: Anthem Medicaid |
$132.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,515.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$300.30
|
| 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 |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna Commercial |
$319.55
|
| Rate for Payer: First Health Commercial |
$365.75
|
| Rate for Payer: Humana Commercial |
$327.25
|
| Rate for Payer: Humana KY Medicaid |
$132.40
|
| Rate for Payer: Humana Medicare Advantage |
$3,515.31
|
| Rate for Payer: Kentucky WC Medicaid |
$133.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$315.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,218.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$338.80
|
| Rate for Payer: Ohio Health Group HMO |
$288.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$265.65
|
| Rate for Payer: PHCS Commercial |
$369.60
|
| Rate for Payer: United Healthcare All Payer |
$338.80
|
|
|
ESOPHAGOSCOPY RIGID BALLOON(P
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 43195
|
| Hospital Charge Code |
761P1725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$297.01 |
| Rate for Payer: Ambetter Exchange |
$175.42
|
| Rate for Payer: Anthem Medicaid |
$144.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna Commercial |
$297.01
|
| Rate for Payer: Healthspan PPO |
$245.39
|
| Rate for Payer: Humana Medicaid |
$144.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$147.37
|
| Rate for Payer: Molina Healthcare Passport |
$144.48
|
| Rate for Payer: Multiplan PHCS |
$231.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.05
|
| Rate for Payer: UHCCP Medicaid |
$134.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.42
|
|
|
ESOPHAGOSCOPY RIGID TRNSO D(P
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 43191
|
| Hospital Charge Code |
761P1723
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Ambetter Exchange |
$147.21
|
| Rate for Payer: Anthem Medicaid |
$101.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$147.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$176.65
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$208.27
|
| Rate for Payer: Healthspan PPO |
$171.90
|
| Rate for Payer: Humana Medicaid |
$101.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$147.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.18
|
| Rate for Payer: Molina Healthcare Passport |
$101.16
|
| Rate for Payer: Multiplan PHCS |
$213.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$191.37
|
| Rate for Payer: UHCCP Medicaid |
$124.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.21
|
|
|
ESOPHAGOSCOPY RIGID TRNSO DX
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 43191
|
| Hospital Charge Code |
76101723
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.08 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem Medicaid |
$122.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| 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 |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Humana KY Medicaid |
$122.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$123.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.95
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
ESOPHAGOSCOPY RIGID TRNSO DX
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 43191
|
| Hospital Charge Code |
76101723
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Ambetter Exchange |
$147.21
|
| Rate for Payer: Anthem Medicaid |
$101.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$147.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$176.65
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$208.27
|
| Rate for Payer: Healthspan PPO |
$171.90
|
| Rate for Payer: Humana Medicaid |
$101.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$147.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.18
|
| Rate for Payer: Molina Healthcare Passport |
$101.16
|
| Rate for Payer: Multiplan PHCS |
$213.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$191.37
|
| Rate for Payer: UHCCP Medicaid |
$124.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.21
|
|
|
ESOPHAGOSCOPY RIGID TRNSO DX
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 43191
|
| Hospital Charge Code |
76101723
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.95
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
ESOPHAGOSCOPY(T
|
Facility
|
OP
|
$2,773.75
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
761T1728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$953.89 |
| Max. Negotiated Rate |
$2,662.80 |
| Rate for Payer: Aetna Commercial |
$2,135.79
|
| Rate for Payer: Anthem Medicaid |
$953.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,163.53
|
| 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 |
$1,386.88
|
| Rate for Payer: Cash Price |
$1,386.88
|
| Rate for Payer: Cigna Commercial |
$2,302.21
|
| Rate for Payer: First Health Commercial |
$2,635.06
|
| Rate for Payer: Humana Commercial |
$2,357.69
|
| Rate for Payer: Humana KY Medicaid |
$953.89
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$963.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,274.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,047.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,440.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,080.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,219.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,413.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,913.89
|
| Rate for Payer: PHCS Commercial |
$2,662.80
|
| Rate for Payer: United Healthcare All Payer |
$2,440.90
|
|
|
ESOPHAGOSCOPY(T
|
Facility
|
IP
|
$2,684.13
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
761T1726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$805.24 |
| Max. Negotiated Rate |
$2,576.76 |
| Rate for Payer: Aetna Commercial |
$2,066.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,093.62
|
| Rate for Payer: Cash Price |
$1,342.07
|
| Rate for Payer: Cigna Commercial |
$2,227.83
|
| Rate for Payer: First Health Commercial |
$2,549.92
|
| Rate for Payer: Humana Commercial |
$2,281.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,200.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,980.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,362.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,013.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,147.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,335.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,852.05
|
| Rate for Payer: PHCS Commercial |
$2,576.76
|
| Rate for Payer: United Healthcare All Payer |
$2,362.03
|
|
|
ESOPHAGOSCOPY(T
|
Facility
|
OP
|
$2,684.13
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
761T1726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.29 |
| Max. Negotiated Rate |
$2,576.76 |
| Rate for Payer: Aetna Commercial |
$2,066.78
|
| Rate for Payer: Anthem Medicaid |
$923.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,093.62
|
| 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 |
$1,342.07
|
| Rate for Payer: Cash Price |
$1,342.07
|
| Rate for Payer: Cigna Commercial |
$2,227.83
|
| Rate for Payer: First Health Commercial |
$2,549.92
|
| Rate for Payer: Humana Commercial |
$2,281.51
|
| Rate for Payer: Humana KY Medicaid |
$923.07
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$932.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,200.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,980.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$941.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,362.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,013.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,147.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,335.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,852.05
|
| Rate for Payer: PHCS Commercial |
$2,576.76
|
| Rate for Payer: United Healthcare All Payer |
$2,362.03
|
|
|
ESOPHAGOSCOPY(T
|
Facility
|
IP
|
$2,773.75
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
761T1728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$832.12 |
| Max. Negotiated Rate |
$2,662.80 |
| Rate for Payer: Aetna Commercial |
$2,135.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,163.53
|
| Rate for Payer: Cash Price |
$1,386.88
|
| Rate for Payer: Cigna Commercial |
$2,302.21
|
| Rate for Payer: First Health Commercial |
$2,635.06
|
| Rate for Payer: Humana Commercial |
$2,357.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,274.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,047.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$832.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,440.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,080.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,219.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,413.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,913.89
|
| Rate for Payer: PHCS Commercial |
$2,662.80
|
| Rate for Payer: United Healthcare All Payer |
$2,440.90
|
|
|
ESOPHAGOSCP RIG TRNSO REM FB
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
HCPCS 43194
|
| Hospital Charge Code |
76101724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$619.20 |
| Rate for Payer: Aetna Commercial |
$496.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$503.10
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$535.35
|
| Rate for Payer: First Health Commercial |
$612.75
|
| Rate for Payer: Humana Commercial |
$548.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$528.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$476.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$567.60
|
| Rate for Payer: Ohio Health Group HMO |
$483.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$516.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$445.05
|
| Rate for Payer: PHCS Commercial |
$619.20
|
| Rate for Payer: United Healthcare All Payer |
$567.60
|
|
|
ESOPHAGOSCP RIG TRNSO REM FB
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 43194
|
| Hospital Charge Code |
76101724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.82 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$496.65
|
| Rate for Payer: Anthem Medicaid |
$221.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$503.10
|
| 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 |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$535.35
|
| Rate for Payer: First Health Commercial |
$612.75
|
| Rate for Payer: Humana Commercial |
$548.25
|
| Rate for Payer: Humana KY Medicaid |
$221.82
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$224.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$528.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$476.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$226.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$567.60
|
| Rate for Payer: Ohio Health Group HMO |
$483.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$516.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$445.05
|
| Rate for Payer: PHCS Commercial |
$619.20
|
| Rate for Payer: United Healthcare All Payer |
$567.60
|
|
|
ESOPHAGOSCP RIG TRNSO REM FB
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 43194
|
| Hospital Charge Code |
76101724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Ambetter Exchange |
$182.44
|
| Rate for Payer: Anthem Medicaid |
$131.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$182.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$182.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$218.93
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$270.07
|
| Rate for Payer: Healthspan PPO |
$223.52
|
| Rate for Payer: Humana Medicaid |
$131.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$182.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$182.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$134.44
|
| Rate for Payer: Molina Healthcare Passport |
$131.80
|
| Rate for Payer: Multiplan PHCS |
$387.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$237.17
|
| Rate for Payer: UHCCP Medicaid |
$225.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$133.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$182.44
|
|
|
ESOPHAGOSCP RIG TRNSO REM F(P
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 43194
|
| Hospital Charge Code |
761P1724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Ambetter Exchange |
$182.44
|
| Rate for Payer: Anthem Medicaid |
$131.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$182.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$182.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$218.93
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$270.07
|
| Rate for Payer: Healthspan PPO |
$223.52
|
| Rate for Payer: Humana Medicaid |
$131.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$182.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$182.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$134.44
|
| Rate for Payer: Molina Healthcare Passport |
$131.80
|
| Rate for Payer: Multiplan PHCS |
$387.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$237.17
|
| Rate for Payer: UHCCP Medicaid |
$225.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$133.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$182.44
|
|
|
ESOPHAGRAM AIR CONTRAST
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 74221
|
| Hospital Charge Code |
32000374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$189.12 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.66
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.93
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
ESOPHAGRAM AIR CONTRAST
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 74221
|
| Hospital Charge Code |
32000374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.75 |
| Max. Negotiated Rate |
$230.29 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem Medicaid |
$67.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Humana KY Medicaid |
$67.75
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$68.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.93
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$686.36
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$686.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
|
|
ESOPHAGUS MOTILITY STUDY
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
ESOPHAGUS MOTILITY STUDY
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$87.57 |
| Max. Negotiated Rate |
$925.20 |
| Rate for Payer: Aetna Commercial |
$281.95
|
| Rate for Payer: Ambetter Exchange |
$194.62
|
| Rate for Payer: Anthem Medicaid |
$113.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$194.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$194.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.54
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$265.76
|
| Rate for Payer: Healthspan PPO |
$230.73
|
| Rate for Payer: Humana Medicaid |
$113.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$194.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$115.97
|
| Rate for Payer: Molina Healthcare Passport |
$113.70
|
| Rate for Payer: Multiplan PHCS |
$925.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$253.01
|
| Rate for Payer: UHCCP Medicaid |
$539.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$114.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$194.62
|
|
|
ESOPHAGUS MOTILITY STUDY
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
ESOPHAGUS MOTILITY STUDY(P
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
750P0001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$87.57 |
| Max. Negotiated Rate |
$281.95 |
| Rate for Payer: Aetna Commercial |
$281.95
|
| Rate for Payer: Ambetter Exchange |
$194.62
|
| Rate for Payer: Anthem Medicaid |
$113.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$194.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$194.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.54
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$265.76
|
| Rate for Payer: Healthspan PPO |
$230.73
|
| Rate for Payer: Humana Medicaid |
$113.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$194.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$115.97
|
| Rate for Payer: Molina Healthcare Passport |
$113.70
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$253.01
|
| Rate for Payer: UHCCP Medicaid |
$126.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$114.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$194.62
|
|
|
ESOPHAGUS MOTILITY STUDY(T
|
Facility
|
OP
|
$1,182.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
750T0001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$406.49 |
| Max. Negotiated Rate |
$1,134.72 |
| Rate for Payer: Aetna Commercial |
$910.14
|
| Rate for Payer: Anthem Medicaid |
$406.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$921.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$981.06
|
| Rate for Payer: First Health Commercial |
$1,122.90
|
| Rate for Payer: Humana Commercial |
$1,004.70
|
| Rate for Payer: Humana KY Medicaid |
$406.49
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$410.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$969.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$872.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$414.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,040.16
|
| Rate for Payer: Ohio Health Group HMO |
$886.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$945.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$815.58
|
| Rate for Payer: PHCS Commercial |
$1,134.72
|
| Rate for Payer: United Healthcare All Payer |
$1,040.16
|
|
