|
ESOPHAGUS MOTILITY STUDY(T
|
Facility
|
IP
|
$1,182.00
|
|
|
Service Code
|
HCPCS 91010
|
| Hospital Charge Code |
750T0001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$1,134.72 |
| Rate for Payer: Aetna Commercial |
$910.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$921.96
|
| 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: 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 |
$354.60
|
| 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
|
|
|
ESOPHAGUS NEEDLE ASPIRATION
|
Facility
|
IP
|
$4,568.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
76101735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,370.40 |
| Max. Negotiated Rate |
$4,385.28 |
| Rate for Payer: Aetna Commercial |
$3,517.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,563.04
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cigna Commercial |
$3,791.44
|
| Rate for Payer: First Health Commercial |
$4,339.60
|
| Rate for Payer: Humana Commercial |
$3,882.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,745.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,371.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,370.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,019.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,654.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,974.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,151.92
|
| Rate for Payer: PHCS Commercial |
$4,385.28
|
| Rate for Payer: United Healthcare All Payer |
$4,019.84
|
|
|
ESOPHAGUS NEEDLE ASPIRATION
|
Facility
|
OP
|
$4,568.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
76101735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,570.94 |
| Max. Negotiated Rate |
$4,385.28 |
| Rate for Payer: Aetna Commercial |
$3,517.36
|
| Rate for Payer: Anthem Medicaid |
$1,570.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,563.04
|
| 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 |
$2,284.00
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cigna Commercial |
$3,791.44
|
| Rate for Payer: First Health Commercial |
$4,339.60
|
| Rate for Payer: Humana Commercial |
$3,882.80
|
| Rate for Payer: Humana KY Medicaid |
$1,570.94
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,586.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,745.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,371.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,602.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,019.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,654.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,974.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,151.92
|
| Rate for Payer: PHCS Commercial |
$4,385.28
|
| Rate for Payer: United Healthcare All Payer |
$4,019.84
|
|
|
ESOPHAGUS NEEDLE ASPIRATION
|
Professional
|
Both
|
$4,568.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
76101735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.55 |
| Max. Negotiated Rate |
$2,740.80 |
| Rate for Payer: Aetna Commercial |
$400.54
|
| Rate for Payer: Ambetter Exchange |
$184.55
|
| Rate for Payer: Anthem Medicaid |
$198.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$184.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$184.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$221.46
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cigna Commercial |
$364.70
|
| Rate for Payer: Healthspan PPO |
$337.78
|
| Rate for Payer: Humana Medicaid |
$198.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$343.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$184.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.80
|
| Rate for Payer: Molina Healthcare Passport |
$198.82
|
| Rate for Payer: Multiplan PHCS |
$2,740.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$239.91
|
| Rate for Payer: UHCCP Medicaid |
$1,598.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$184.55
|
|
|
ESOPHAGUS NEEDLE ASPIRATION(P
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
761P1735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$400.54 |
| Rate for Payer: Aetna Commercial |
$400.54
|
| Rate for Payer: Ambetter Exchange |
$184.55
|
| Rate for Payer: Anthem Medicaid |
$198.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$184.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$184.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$221.46
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$364.70
|
| Rate for Payer: Healthspan PPO |
$337.78
|
| Rate for Payer: Humana Medicaid |
$198.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$343.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$184.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.80
|
| Rate for Payer: Molina Healthcare Passport |
$198.82
|
| Rate for Payer: Multiplan PHCS |
$282.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$239.91
|
| Rate for Payer: UHCCP Medicaid |
$164.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$184.55
|
|
|
ESOPHAGUS NEEDLE ASPIRATION(T
|
Facility
|
IP
|
$4,098.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
761T1735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,229.40 |
| Max. Negotiated Rate |
$3,934.08 |
| Rate for Payer: Aetna Commercial |
$3,155.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.44
|
| Rate for Payer: Cash Price |
$2,049.00
|
| Rate for Payer: Cigna Commercial |
$3,401.34
|
| Rate for Payer: First Health Commercial |
$3,893.10
|
| Rate for Payer: Humana Commercial |
$3,483.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,073.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,827.62
|
| Rate for Payer: PHCS Commercial |
$3,934.08
|
| Rate for Payer: United Healthcare All Payer |
$3,606.24
|
|
|
ESOPHAGUS NEEDLE ASPIRATION(T
|
Facility
|
OP
|
$4,098.00
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
761T1735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,409.30 |
| Max. Negotiated Rate |
$3,934.08 |
| Rate for Payer: Aetna Commercial |
$3,155.46
|
| Rate for Payer: Anthem Medicaid |
$1,409.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.44
|
| 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 |
$2,049.00
|
| Rate for Payer: Cash Price |
$2,049.00
|
| Rate for Payer: Cigna Commercial |
$3,401.34
|
| Rate for Payer: First Health Commercial |
$3,893.10
|
| Rate for Payer: Humana Commercial |
$3,483.30
|
| Rate for Payer: Humana KY Medicaid |
$1,409.30
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,437.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,073.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,827.62
|
| Rate for Payer: PHCS Commercial |
$3,934.08
|
| Rate for Payer: United Healthcare All Payer |
$3,606.24
|
|
|
ESOPHAGUS ULTRASOUND
|
Facility
|
IP
|
$3,824.93
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
76101734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,147.48 |
| Max. Negotiated Rate |
$3,671.93 |
| Rate for Payer: Aetna Commercial |
$2,945.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,983.45
|
| Rate for Payer: Cash Price |
$1,912.46
|
| Rate for Payer: Cigna Commercial |
$3,174.69
|
| Rate for Payer: First Health Commercial |
$3,633.68
|
| Rate for Payer: Humana Commercial |
$3,251.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,136.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,147.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,365.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,868.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,059.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,327.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,639.20
|
| Rate for Payer: PHCS Commercial |
$3,671.93
|
| Rate for Payer: United Healthcare All Payer |
$3,365.94
|
|
|
ESOPHAGUS ULTRASOUND
|
Facility
|
OP
|
$3,824.93
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
76101734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,315.39 |
| Max. Negotiated Rate |
$3,671.93 |
| Rate for Payer: Aetna Commercial |
$2,945.20
|
| Rate for Payer: Anthem Medicaid |
$1,315.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,983.45
|
| 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 |
$1,912.46
|
| Rate for Payer: Cash Price |
$1,912.46
|
| Rate for Payer: Cigna Commercial |
$3,174.69
|
| Rate for Payer: First Health Commercial |
$3,633.68
|
| Rate for Payer: Humana Commercial |
$3,251.19
|
| Rate for Payer: Humana KY Medicaid |
$1,315.39
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,328.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,136.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,341.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,365.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,868.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,059.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,327.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,639.20
|
| Rate for Payer: PHCS Commercial |
$3,671.93
|
| Rate for Payer: United Healthcare All Payer |
$3,365.94
|
|
|
ESOPHAGUS ULTRASOUND
|
Professional
|
Both
|
$3,824.93
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
76101734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$2,294.96 |
| Rate for Payer: Aetna Commercial |
$289.92
|
| Rate for Payer: Ambetter Exchange |
$145.05
|
| Rate for Payer: Anthem Medicaid |
$171.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$145.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$145.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$174.06
|
| Rate for Payer: Cash Price |
$1,912.46
|
| Rate for Payer: Cash Price |
$1,912.46
|
| Rate for Payer: Cigna Commercial |
$260.79
|
| Rate for Payer: Healthspan PPO |
$244.50
|
| Rate for Payer: Humana Medicaid |
$171.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$249.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$145.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.62
|
| Rate for Payer: Molina Healthcare Passport |
$171.20
|
| Rate for Payer: Multiplan PHCS |
$2,294.96
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.56
|
| Rate for Payer: UHCCP Medicaid |
$1,338.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$145.05
|
|
|
ESOPHAGUS ULTRASOUND(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
761P1734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$289.92 |
| Rate for Payer: Aetna Commercial |
$289.92
|
| Rate for Payer: Ambetter Exchange |
$145.05
|
| Rate for Payer: Anthem Medicaid |
$171.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$145.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$145.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$174.06
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$260.79
|
| Rate for Payer: Healthspan PPO |
$244.50
|
| Rate for Payer: Humana Medicaid |
$171.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$249.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$145.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.62
|
| Rate for Payer: Molina Healthcare Passport |
$171.20
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.56
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$145.05
|
|
|
ESOPHAGUS ULTRASOUND(T
|
Facility
|
IP
|
$3,474.93
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
761T1734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,042.48 |
| Max. Negotiated Rate |
$3,335.93 |
| Rate for Payer: Aetna Commercial |
$2,675.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,710.45
|
| Rate for Payer: Cash Price |
$1,737.46
|
| Rate for Payer: Cigna Commercial |
$2,884.19
|
| Rate for Payer: First Health Commercial |
$3,301.18
|
| Rate for Payer: Humana Commercial |
$2,953.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,849.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,564.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,042.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,057.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,606.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,779.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,023.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.70
|
| Rate for Payer: PHCS Commercial |
$3,335.93
|
| Rate for Payer: United Healthcare All Payer |
$3,057.94
|
|
|
ESOPHAGUS ULTRASOUND(T
|
Facility
|
OP
|
$3,474.93
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
761T1734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,195.03 |
| Max. Negotiated Rate |
$3,335.93 |
| Rate for Payer: Aetna Commercial |
$2,675.70
|
| Rate for Payer: Anthem Medicaid |
$1,195.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,710.45
|
| 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 |
$1,737.46
|
| Rate for Payer: Cash Price |
$1,737.46
|
| Rate for Payer: Cigna Commercial |
$2,884.19
|
| Rate for Payer: First Health Commercial |
$3,301.18
|
| Rate for Payer: Humana Commercial |
$2,953.69
|
| Rate for Payer: Humana KY Medicaid |
$1,195.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,207.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,849.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,564.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,219.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,057.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,606.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,779.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,023.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.70
|
| Rate for Payer: PHCS Commercial |
$3,335.93
|
| Rate for Payer: United Healthcare All Payer |
$3,057.94
|
|
|
ESOPH ENDOSCOPE - DILATION
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
76101745
|
|
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
|
|
|
ESOPH ENDOSCOPE - DILATION
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
76101745
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.11 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$266.04
|
| Rate for Payer: Ambetter Exchange |
$143.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$145.61
|
| Rate for Payer: Anthem Medicaid |
$192.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$143.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$171.73
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$239.34
|
| Rate for Payer: Healthspan PPO |
$224.36
|
| Rate for Payer: Humana Medicaid |
$192.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$143.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$196.28
|
| Rate for Payer: Molina Healthcare Passport |
$192.43
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$186.04
|
| Rate for Payer: UHCCP Medicaid |
$152.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$194.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.11
|
|
|
ESOPH ENDOSCOPE - DILATION
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
76101745
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.53 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$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 |
$1,752.78
|
| 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 |
$2,103.34
|
| 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
|
|
|
ESOPH ENDOSCOPE - DILATION(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
761P1745
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.11 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$266.04
|
| Rate for Payer: Ambetter Exchange |
$143.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$145.61
|
| Rate for Payer: Anthem Medicaid |
$192.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$143.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$171.73
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$239.34
|
| Rate for Payer: Healthspan PPO |
$224.36
|
| Rate for Payer: Humana Medicaid |
$192.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$143.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$196.28
|
| Rate for Payer: Molina Healthcare Passport |
$192.43
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$186.04
|
| Rate for Payer: UHCCP Medicaid |
$152.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$194.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.11
|
|
|
ESOPH FUNC PROLONG 1HR-24HR
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
HCPCS 91038
|
| Hospital Charge Code |
75000005
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$991.68 |
| Rate for Payer: Aetna Commercial |
$795.41
|
| Rate for Payer: Anthem Medicaid |
$355.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$805.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$516.50
|
| Rate for Payer: Cash Price |
$516.50
|
| Rate for Payer: Cigna Commercial |
$857.39
|
| Rate for Payer: First Health Commercial |
$981.35
|
| Rate for Payer: Humana Commercial |
$878.05
|
| Rate for Payer: Humana KY Medicaid |
$355.25
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$358.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$847.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$762.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$362.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$909.04
|
| Rate for Payer: Ohio Health Group HMO |
$774.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$826.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$712.77
|
| Rate for Payer: PHCS Commercial |
$991.68
|
| Rate for Payer: United Healthcare All Payer |
$909.04
|
|
|
ESOPH FUNC PROLONG 1HR-24HR
|
Professional
|
Both
|
$1,033.00
|
|
|
Service Code
|
HCPCS 91038
|
| Hospital Charge Code |
75000005
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$75.36 |
| Max. Negotiated Rate |
$619.80 |
| Rate for Payer: Aetna Commercial |
$210.67
|
| Rate for Payer: Ambetter Exchange |
$344.93
|
| Rate for Payer: Anthem Medicaid |
$92.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$344.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$344.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.92
|
| Rate for Payer: Cash Price |
$516.50
|
| Rate for Payer: Cash Price |
$516.50
|
| Rate for Payer: Cigna Commercial |
$169.91
|
| Rate for Payer: Healthspan PPO |
$172.40
|
| Rate for Payer: Humana Medicaid |
$92.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$344.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.24
|
| Rate for Payer: Molina Healthcare Passport |
$92.39
|
| Rate for Payer: Multiplan PHCS |
$619.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.41
|
| Rate for Payer: UHCCP Medicaid |
$361.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$344.93
|
|
|
ESOPH FUNC PROLONG 1HR-24HR
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
HCPCS 91038
|
| Hospital Charge Code |
75000005
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$309.90 |
| Max. Negotiated Rate |
$991.68 |
| Rate for Payer: Aetna Commercial |
$795.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$805.74
|
| Rate for Payer: Cash Price |
$516.50
|
| Rate for Payer: Cigna Commercial |
$857.39
|
| Rate for Payer: First Health Commercial |
$981.35
|
| Rate for Payer: Humana Commercial |
$878.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$847.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$762.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$909.04
|
| Rate for Payer: Ohio Health Group HMO |
$774.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$826.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$712.77
|
| Rate for Payer: PHCS Commercial |
$991.68
|
| Rate for Payer: United Healthcare All Payer |
$909.04
|
|
|
ESOPH FUNC PROLONG 1HR-24HR(P
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 91038
|
| Hospital Charge Code |
750P0005
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$75.36 |
| Max. Negotiated Rate |
$448.41 |
| Rate for Payer: Aetna Commercial |
$210.67
|
| Rate for Payer: Ambetter Exchange |
$344.93
|
| Rate for Payer: Anthem Medicaid |
$92.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$344.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$344.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.92
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$169.91
|
| Rate for Payer: Healthspan PPO |
$172.40
|
| Rate for Payer: Humana Medicaid |
$92.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$344.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.24
|
| Rate for Payer: Molina Healthcare Passport |
$92.39
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.41
|
| Rate for Payer: UHCCP Medicaid |
$94.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$344.93
|
|
|
ESOPH FUNC PROLONG 1HR-24HR(T
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS 91038
|
| Hospital Charge Code |
750T0005
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$262.40 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem Medicaid |
$262.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Humana KY Medicaid |
$262.40
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$265.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.47
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
ESOPH FUNC PROLONG 1HR-24HR(T
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
HCPCS 91038
|
| Hospital Charge Code |
750T0005
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$228.90 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.47
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
ESOPH FUNDOPLASTY LAP
|
Professional
|
Both
|
$1,925.00
|
|
|
Service Code
|
HCPCS 43327
|
| Hospital Charge Code |
76101769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$673.75 |
| Max. Negotiated Rate |
$1,396.89 |
| Rate for Payer: Aetna Commercial |
$1,340.53
|
| Rate for Payer: Ambetter Exchange |
$795.06
|
| Rate for Payer: Anthem Medicaid |
$721.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$795.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$795.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$954.07
|
| Rate for Payer: Cash Price |
$962.50
|
| Rate for Payer: Cash Price |
$962.50
|
| Rate for Payer: Cigna Commercial |
$1,396.89
|
| Rate for Payer: Healthspan PPO |
$848.66
|
| Rate for Payer: Humana Medicaid |
$721.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,068.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$795.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$795.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$735.71
|
| Rate for Payer: Molina Healthcare Passport |
$721.28
|
| Rate for Payer: Multiplan PHCS |
$1,155.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,033.58
|
| Rate for Payer: UHCCP Medicaid |
$673.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$728.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$795.06
|
|
|
ESOPH FUNDOPLASTY LAP
|
Facility
|
IP
|
$1,925.00
|
|
|
Service Code
|
HCPCS 43327
|
| Hospital Charge Code |
76101769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,848.00 |
| Rate for Payer: Aetna Commercial |
$1,482.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,501.50
|
| Rate for Payer: Cash Price |
$962.50
|
| Rate for Payer: Cigna Commercial |
$1,597.75
|
| Rate for Payer: First Health Commercial |
$1,828.75
|
| Rate for Payer: Humana Commercial |
$1,636.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,578.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,420.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,443.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,674.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,328.25
|
| Rate for Payer: PHCS Commercial |
$1,848.00
|
| Rate for Payer: United Healthcare All Payer |
$1,694.00
|
|
