GASTRE PARTIAL - DISL; GASTRO
|
Facility
|
IP
|
$3,000.00
|
|
Service Code
|
HCPCS 43632
|
Hospital Charge Code |
76101785
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$390.00 |
Max. Negotiated Rate |
$2,880.00 |
Rate for Payer: Aetna Commercial |
$2,310.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
Rate for Payer: Cash Price |
$1,500.00
|
Rate for Payer: Cigna Commercial |
$2,490.00
|
Rate for Payer: First Health Commercial |
$2,850.00
|
Rate for Payer: Humana Commercial |
$2,550.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
Rate for Payer: PHCS Commercial |
$2,880.00
|
Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
GASTRE PARTIAL - DISL; GASTR(P
|
Professional
|
Both
|
$3,000.00
|
|
Service Code
|
HCPCS 43632
|
Hospital Charge Code |
761P1785
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$928.88 |
Max. Negotiated Rate |
$3,000.00 |
Rate for Payer: Aetna Commercial |
$2,832.92
|
Rate for Payer: Anthem Medicaid |
$928.88
|
Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
Rate for Payer: Cash Price |
$1,500.00
|
Rate for Payer: Cash Price |
$1,500.00
|
Rate for Payer: Cigna Commercial |
$2,563.49
|
Rate for Payer: Healthspan PPO |
$2,389.05
|
Rate for Payer: Humana Medicaid |
$928.88
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,584.62
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$947.46
|
Rate for Payer: Molina Healthcare Passport |
$928.88
|
Rate for Payer: Multiplan PHCS |
$1,800.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
Rate for Payer: UHCCP Medicaid |
$1,050.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$938.17
|
|
GASTRIC EMPTYING IMAG STUDY
|
Professional
|
Both
|
$1,906.00
|
|
Service Code
|
HCPCS 78264
|
Hospital Charge Code |
34000011
|
Hospital Revenue Code
|
340
|
Min. Negotiated Rate |
$43.45 |
Max. Negotiated Rate |
$1,906.00 |
Rate for Payer: Aetna Commercial |
$407.49
|
Rate for Payer: Anthem Medicaid |
$145.24
|
Rate for Payer: Buckeye Medicare Advantage |
$1,906.00
|
Rate for Payer: Cash Price |
$953.00
|
Rate for Payer: Cash Price |
$953.00
|
Rate for Payer: Cigna Commercial |
$330.10
|
Rate for Payer: Healthspan PPO |
$407.28
|
Rate for Payer: Humana Medicaid |
$145.24
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.45
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.14
|
Rate for Payer: Molina Healthcare Passport |
$145.24
|
Rate for Payer: Multiplan PHCS |
$1,143.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,334.20
|
Rate for Payer: UHCCP Medicaid |
$667.10
|
Rate for Payer: Wellcare CHIP/Medicaid |
$146.69
|
|
GASTRIC EMPTYING IMAG STUDY
|
Facility
|
OP
|
$1,906.00
|
|
Service Code
|
HCPCS 78264
|
Hospital Charge Code |
34000011
|
Hospital Revenue Code
|
340
|
Min. Negotiated Rate |
$247.78 |
Max. Negotiated Rate |
$1,829.76 |
Rate for Payer: Aetna Commercial |
$1,467.62
|
Rate for Payer: Anthem Medicaid |
$655.47
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,486.68
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
Rate for Payer: Cash Price |
$953.00
|
Rate for Payer: Cash Price |
$953.00
|
Rate for Payer: Cigna Commercial |
$1,581.98
|
Rate for Payer: First Health Commercial |
$1,810.70
|
Rate for Payer: Humana Commercial |
$1,620.10
|
Rate for Payer: Humana KY Medicaid |
$655.47
|
Rate for Payer: Humana Medicare Advantage |
$356.66
|
Rate for Payer: Kentucky WC Medicaid |
$662.14
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,562.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,406.63
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
Rate for Payer: Molina Healthcare Medicaid |
$668.62
|
Rate for Payer: Ohio Health Choice Commercial |
$1,677.28
|
Rate for Payer: Ohio Health Group HMO |
$1,429.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$381.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$247.78
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$590.86
|
Rate for Payer: PHCS Commercial |
$1,829.76
|
Rate for Payer: United Healthcare All Payer |
$1,677.28
|
|
GASTRIC EMPTYING IMAG STUDY
|
Facility
|
IP
|
$1,906.00
|
|
Service Code
|
HCPCS 78264
|
Hospital Charge Code |
34000011
|
Hospital Revenue Code
|
340
|
Min. Negotiated Rate |
$247.78 |
Max. Negotiated Rate |
$1,829.76 |
Rate for Payer: Aetna Commercial |
$1,467.62
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,486.68
|
Rate for Payer: Cash Price |
$953.00
|
Rate for Payer: Cigna Commercial |
$1,581.98
|
Rate for Payer: First Health Commercial |
$1,810.70
|
Rate for Payer: Humana Commercial |
$1,620.10
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,562.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,406.63
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$571.80
|
Rate for Payer: Ohio Health Choice Commercial |
$1,677.28
|
Rate for Payer: Ohio Health Group HMO |
$1,429.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$381.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$247.78
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$590.86
|
Rate for Payer: PHCS Commercial |
$1,829.76
|
Rate for Payer: United Healthcare All Payer |
$1,677.28
|
|
GASTRIC EMPTYING IMAG STUDY(P
|
Professional
|
Both
|
$150.00
|
|
Service Code
|
HCPCS 78264
|
Hospital Charge Code |
340P0011
|
Hospital Revenue Code
|
340
|
Min. Negotiated Rate |
$43.45 |
Max. Negotiated Rate |
$407.49 |
Rate for Payer: Aetna Commercial |
$407.49
|
Rate for Payer: Anthem Medicaid |
$145.24
|
Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
Rate for Payer: Cash Price |
$75.00
|
Rate for Payer: Cash Price |
$75.00
|
Rate for Payer: Cigna Commercial |
$330.10
|
Rate for Payer: Healthspan PPO |
$407.28
|
Rate for Payer: Humana Medicaid |
$145.24
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.45
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.14
|
Rate for Payer: Molina Healthcare Passport |
$145.24
|
Rate for Payer: Multiplan PHCS |
$90.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
Rate for Payer: UHCCP Medicaid |
$52.50
|
Rate for Payer: Wellcare CHIP/Medicaid |
$146.69
|
|
GASTRIC EMPTYING IMAG STUDY(T
|
Facility
|
OP
|
$1,756.00
|
|
Service Code
|
HCPCS 78264
|
Hospital Charge Code |
340T0011
|
Hospital Revenue Code
|
340
|
Min. Negotiated Rate |
$228.28 |
Max. Negotiated Rate |
$1,685.76 |
Rate for Payer: Aetna Commercial |
$1,352.12
|
Rate for Payer: Anthem Medicaid |
$603.89
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.68
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
Rate for Payer: Cash Price |
$878.00
|
Rate for Payer: Cash Price |
$878.00
|
Rate for Payer: Cigna Commercial |
$1,457.48
|
Rate for Payer: First Health Commercial |
$1,668.20
|
Rate for Payer: Humana Commercial |
$1,492.60
|
Rate for Payer: Humana KY Medicaid |
$603.89
|
Rate for Payer: Humana Medicare Advantage |
$356.66
|
Rate for Payer: Kentucky WC Medicaid |
$610.03
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.93
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
Rate for Payer: Molina Healthcare Medicaid |
$616.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,545.28
|
Rate for Payer: Ohio Health Group HMO |
$1,317.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$351.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$228.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.36
|
Rate for Payer: PHCS Commercial |
$1,685.76
|
Rate for Payer: United Healthcare All Payer |
$1,545.28
|
|
GASTRIC EMPTYING IMAG STUDY(T
|
Facility
|
IP
|
$1,756.00
|
|
Service Code
|
HCPCS 78264
|
Hospital Charge Code |
340T0011
|
Hospital Revenue Code
|
340
|
Min. Negotiated Rate |
$228.28 |
Max. Negotiated Rate |
$1,685.76 |
Rate for Payer: Aetna Commercial |
$1,352.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.68
|
Rate for Payer: Cash Price |
$878.00
|
Rate for Payer: Cigna Commercial |
$1,457.48
|
Rate for Payer: First Health Commercial |
$1,668.20
|
Rate for Payer: Humana Commercial |
$1,492.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.93
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$526.80
|
Rate for Payer: Ohio Health Choice Commercial |
$1,545.28
|
Rate for Payer: Ohio Health Group HMO |
$1,317.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$351.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$228.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.36
|
Rate for Payer: PHCS Commercial |
$1,685.76
|
Rate for Payer: United Healthcare All Payer |
$1,545.28
|
|
GASTRIC INTUB&ASPIRA LAVAGE
|
Facility
|
OP
|
$394.00
|
|
Service Code
|
HCPCS 43753
|
Hospital Charge Code |
45000266
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$51.22 |
Max. Negotiated Rate |
$380.00 |
Rate for Payer: Aetna Commercial |
$303.38
|
Rate for Payer: Anthem Medicaid |
$135.50
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$307.32
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
Rate for Payer: Cash Price |
$197.00
|
Rate for Payer: Cash Price |
$197.00
|
Rate for Payer: Cigna Commercial |
$327.02
|
Rate for Payer: First Health Commercial |
$374.30
|
Rate for Payer: Humana Commercial |
$334.90
|
Rate for Payer: Humana KY Medicaid |
$135.50
|
Rate for Payer: Humana Medicare Advantage |
$271.43
|
Rate for Payer: Kentucky WC Medicaid |
$136.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
Rate for Payer: Molina Healthcare Medicaid |
$138.22
|
Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
Rate for Payer: Ohio Health Group HMO |
$295.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$78.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$51.22
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.14
|
Rate for Payer: PHCS Commercial |
$378.24
|
Rate for Payer: United Healthcare All Payer |
$346.72
|
|
GASTRIC INTUB&ASPIRA LAVAGE
|
Facility
|
IP
|
$363.00
|
|
Service Code
|
HCPCS 43753
|
Hospital Charge Code |
76101791
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$47.19 |
Max. Negotiated Rate |
$348.48 |
Rate for Payer: Aetna Commercial |
$279.51
|
Rate for Payer: Anthem POS/PPO/Traditional |
$283.14
|
Rate for Payer: Cash Price |
$181.50
|
Rate for Payer: Cigna Commercial |
$301.29
|
Rate for Payer: First Health Commercial |
$344.85
|
Rate for Payer: Humana Commercial |
$308.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$297.66
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$267.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$108.90
|
Rate for Payer: Ohio Health Choice Commercial |
$319.44
|
Rate for Payer: Ohio Health Group HMO |
$272.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$72.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$47.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.53
|
Rate for Payer: PHCS Commercial |
$348.48
|
Rate for Payer: United Healthcare All Payer |
$319.44
|
|
GASTRIC INTUB&ASPIRA LAVAGE
|
Facility
|
IP
|
$394.00
|
|
Service Code
|
HCPCS 43753
|
Hospital Charge Code |
45000266
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$51.22 |
Max. Negotiated Rate |
$378.24 |
Rate for Payer: Aetna Commercial |
$303.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$307.32
|
Rate for Payer: Cash Price |
$197.00
|
Rate for Payer: Cigna Commercial |
$327.02
|
Rate for Payer: First Health Commercial |
$374.30
|
Rate for Payer: Humana Commercial |
$334.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$118.20
|
Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
Rate for Payer: Ohio Health Group HMO |
$295.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$78.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$51.22
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.14
|
Rate for Payer: PHCS Commercial |
$378.24
|
Rate for Payer: United Healthcare All Payer |
$346.72
|
|
GASTRIC INTUB&ASPIRA LAVAGE
|
Facility
|
OP
|
$363.00
|
|
Service Code
|
HCPCS 43753
|
Hospital Charge Code |
76101791
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$47.19 |
Max. Negotiated Rate |
$380.00 |
Rate for Payer: Aetna Commercial |
$279.51
|
Rate for Payer: Anthem Medicaid |
$124.84
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$283.14
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
Rate for Payer: Cash Price |
$181.50
|
Rate for Payer: Cash Price |
$181.50
|
Rate for Payer: Cigna Commercial |
$301.29
|
Rate for Payer: First Health Commercial |
$344.85
|
Rate for Payer: Humana Commercial |
$308.55
|
Rate for Payer: Humana KY Medicaid |
$124.84
|
Rate for Payer: Humana Medicare Advantage |
$271.43
|
Rate for Payer: Kentucky WC Medicaid |
$126.11
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$297.66
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$267.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
Rate for Payer: Molina Healthcare Medicaid |
$127.34
|
Rate for Payer: Ohio Health Choice Commercial |
$319.44
|
Rate for Payer: Ohio Health Group HMO |
$272.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$72.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$47.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.53
|
Rate for Payer: PHCS Commercial |
$348.48
|
Rate for Payer: United Healthcare All Payer |
$319.44
|
|
GASTRIC OCCULT BLOOD
|
Facility
|
OP
|
$48.00
|
|
Service Code
|
HCPCS 82271
|
Hospital Charge Code |
30000251
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$5.32 |
Max. Negotiated Rate |
$46.08 |
Rate for Payer: Aetna Commercial |
$36.96
|
Rate for Payer: Anthem Medicaid |
$5.32
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$5.32
|
Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.45
|
Rate for Payer: CareSource Just4Me Medicare |
$5.32
|
Rate for Payer: Cash Price |
$24.00
|
Rate for Payer: Cash Price |
$24.00
|
Rate for Payer: Cigna Commercial |
$39.84
|
Rate for Payer: First Health Commercial |
$45.60
|
Rate for Payer: Humana Commercial |
$40.80
|
Rate for Payer: Humana KY Medicaid |
$5.32
|
Rate for Payer: Humana Medicare Advantage |
$5.32
|
Rate for Payer: Kentucky WC Medicaid |
$5.37
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.38
|
Rate for Payer: Molina Healthcare Medicaid |
$5.43
|
Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
Rate for Payer: Ohio Health Group HMO |
$36.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$9.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$6.24
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.88
|
Rate for Payer: PHCS Commercial |
$46.08
|
Rate for Payer: United Healthcare All Payer |
$42.24
|
|
GASTRIC OCCULT BLOOD
|
Facility
|
IP
|
$48.00
|
|
Service Code
|
HCPCS 82271
|
Hospital Charge Code |
30000251
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$6.24 |
Max. Negotiated Rate |
$46.08 |
Rate for Payer: Aetna Commercial |
$36.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$38.54
|
Rate for Payer: Cash Price |
$24.00
|
Rate for Payer: Cigna Commercial |
$39.84
|
Rate for Payer: First Health Commercial |
$45.60
|
Rate for Payer: Humana Commercial |
$40.80
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
Rate for Payer: Ohio Health Group HMO |
$36.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$9.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$6.24
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.88
|
Rate for Payer: PHCS Commercial |
$46.08
|
Rate for Payer: United Healthcare All Payer |
$42.24
|
|
GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)
|
Facility
|
OP
|
$3,918.70
|
|
Service Code
|
CPT 27687
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$2,799.07 |
Max. Negotiated Rate |
$3,918.70 |
Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
GASTROCNEMIUS RECESS (STRAYER)
|
Professional
|
Both
|
$1,301.00
|
|
Service Code
|
HCPCS 27687
|
Hospital Charge Code |
76102648
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$336.01 |
Max. Negotiated Rate |
$1,301.00 |
Rate for Payer: Aetna Commercial |
$686.42
|
Rate for Payer: Anthem Medicaid |
$336.01
|
Rate for Payer: Buckeye Medicare Advantage |
$1,301.00
|
Rate for Payer: Cash Price |
$650.50
|
Rate for Payer: Cash Price |
$650.50
|
Rate for Payer: Cigna Commercial |
$761.65
|
Rate for Payer: Healthspan PPO |
$621.75
|
Rate for Payer: Humana Medicaid |
$336.01
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$567.06
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$342.73
|
Rate for Payer: Molina Healthcare Passport |
$336.01
|
Rate for Payer: Multiplan PHCS |
$780.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.70
|
Rate for Payer: UHCCP Medicaid |
$455.35
|
Rate for Payer: Wellcare CHIP/Medicaid |
$339.37
|
|
GASTROCUTANEOUS FISTULECTOMY
|
Facility
|
IP
|
$1,845.00
|
|
Service Code
|
HCPCS 43999
|
Hospital Charge Code |
76102900
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$239.85 |
Max. Negotiated Rate |
$1,771.20 |
Rate for Payer: Aetna Commercial |
$1,420.65
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,439.10
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Cigna Commercial |
$1,531.35
|
Rate for Payer: First Health Commercial |
$1,752.75
|
Rate for Payer: Humana Commercial |
$1,568.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.90
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.61
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$553.50
|
Rate for Payer: Ohio Health Choice Commercial |
$1,623.60
|
Rate for Payer: Ohio Health Group HMO |
$1,383.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$369.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$239.85
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.95
|
Rate for Payer: PHCS Commercial |
$1,771.20
|
Rate for Payer: United Healthcare All Payer |
$1,623.60
|
|
GASTROCUTANEOUS FISTULECTOMY
|
Facility
|
OP
|
$1,845.00
|
|
Service Code
|
HCPCS 43999
|
Hospital Charge Code |
76102900
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$239.85 |
Max. Negotiated Rate |
$1,771.20 |
Rate for Payer: Aetna Commercial |
$1,420.65
|
Rate for Payer: Anthem Medicaid |
$634.50
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,439.10
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Cigna Commercial |
$1,531.35
|
Rate for Payer: First Health Commercial |
$1,752.75
|
Rate for Payer: Humana Commercial |
$1,568.25
|
Rate for Payer: Humana KY Medicaid |
$634.50
|
Rate for Payer: Humana Medicare Advantage |
$783.89
|
Rate for Payer: Kentucky WC Medicaid |
$640.95
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.90
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.61
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
Rate for Payer: Molina Healthcare Medicaid |
$647.23
|
Rate for Payer: Ohio Health Choice Commercial |
$1,623.60
|
Rate for Payer: Ohio Health Group HMO |
$1,383.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$369.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$239.85
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.95
|
Rate for Payer: PHCS Commercial |
$1,771.20
|
Rate for Payer: United Healthcare All Payer |
$1,623.60
|
|
GASTROCUTANEOUS FISTULECTOMY
|
Professional
|
Both
|
$1,845.00
|
|
Service Code
|
HCPCS 43999
|
Hospital Charge Code |
76102900
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$0.60 |
Max. Negotiated Rate |
$1,845.00 |
Rate for Payer: Anthem Medicaid |
$75.00
|
Rate for Payer: Buckeye Medicare Advantage |
$1,845.00
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Healthspan PPO |
$0.60
|
Rate for Payer: Humana Medicaid |
$75.00
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.50
|
Rate for Payer: Molina Healthcare Passport |
$75.00
|
Rate for Payer: Multiplan PHCS |
$1,107.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,291.50
|
Rate for Payer: UHCCP Medicaid |
$645.75
|
Rate for Payer: Wellcare CHIP/Medicaid |
$75.75
|
|
GASTROGRAFIN 66-10 1ML(30ML)
|
Facility
|
IP
|
$138.58
|
|
Service Code
|
HCPCS Q9963
|
Hospital Charge Code |
25004218
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$18.02 |
Max. Negotiated Rate |
$133.04 |
Rate for Payer: Aetna Commercial |
$106.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$108.09
|
Rate for Payer: Cash Price |
$69.29
|
Rate for Payer: Cigna Commercial |
$115.02
|
Rate for Payer: First Health Commercial |
$131.65
|
Rate for Payer: Humana Commercial |
$117.79
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$113.64
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.27
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$41.57
|
Rate for Payer: Ohio Health Choice Commercial |
$121.95
|
Rate for Payer: Ohio Health Group HMO |
$103.94
|
Rate for Payer: Ohio Health Group PPO Differential |
$27.72
|
Rate for Payer: Ohio Health Group PPO No Differential |
$18.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.96
|
Rate for Payer: PHCS Commercial |
$133.04
|
Rate for Payer: United Healthcare All Payer |
$121.95
|
|
GASTROGRAFIN 66-10 1ML(30ML)
|
Facility
|
OP
|
$138.58
|
|
Service Code
|
HCPCS Q9963
|
Hospital Charge Code |
25004218
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$18.02 |
Max. Negotiated Rate |
$133.04 |
Rate for Payer: Humana Commercial |
$117.79
|
Rate for Payer: Humana KY Medicaid |
$47.66
|
Rate for Payer: Kentucky WC Medicaid |
$48.14
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$113.64
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.27
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$41.57
|
Rate for Payer: Molina Healthcare Medicaid |
$48.61
|
Rate for Payer: Ohio Health Choice Commercial |
$121.95
|
Rate for Payer: Ohio Health Group HMO |
$103.94
|
Rate for Payer: Ohio Health Group PPO Differential |
$27.72
|
Rate for Payer: Ohio Health Group PPO No Differential |
$18.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.96
|
Rate for Payer: PHCS Commercial |
$133.04
|
Rate for Payer: United Healthcare All Payer |
$121.95
|
Rate for Payer: Aetna Commercial |
$106.71
|
Rate for Payer: Anthem Medicaid |
$47.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$108.09
|
Rate for Payer: Cash Price |
$69.29
|
Rate for Payer: Cigna Commercial |
$115.02
|
Rate for Payer: First Health Commercial |
$131.65
|
|
GASTROGRAFIN 66-10 SOLT 120MLV
|
Facility
|
IP
|
$528.52
|
|
Service Code
|
HCPCS Q9963
|
Hospital Charge Code |
25003814
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$68.71 |
Max. Negotiated Rate |
$507.38 |
Rate for Payer: Aetna Commercial |
$406.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$412.25
|
Rate for Payer: Cash Price |
$264.26
|
Rate for Payer: Cigna Commercial |
$438.67
|
Rate for Payer: First Health Commercial |
$502.09
|
Rate for Payer: Humana Commercial |
$449.24
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$433.39
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$390.05
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$158.56
|
Rate for Payer: Ohio Health Choice Commercial |
$465.10
|
Rate for Payer: Ohio Health Group HMO |
$396.39
|
Rate for Payer: Ohio Health Group PPO Differential |
$105.70
|
Rate for Payer: Ohio Health Group PPO No Differential |
$68.71
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.84
|
Rate for Payer: PHCS Commercial |
$507.38
|
Rate for Payer: United Healthcare All Payer |
$465.10
|
|
GASTROGRAFIN 66-10 SOLT 120MLV
|
Facility
|
OP
|
$528.52
|
|
Service Code
|
HCPCS Q9963
|
Hospital Charge Code |
25003814
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$68.71 |
Max. Negotiated Rate |
$507.38 |
Rate for Payer: Aetna Commercial |
$406.96
|
Rate for Payer: Anthem Medicaid |
$181.76
|
Rate for Payer: Anthem POS/PPO/Traditional |
$412.25
|
Rate for Payer: Cash Price |
$264.26
|
Rate for Payer: Cigna Commercial |
$438.67
|
Rate for Payer: First Health Commercial |
$502.09
|
Rate for Payer: Humana Commercial |
$449.24
|
Rate for Payer: Humana KY Medicaid |
$181.76
|
Rate for Payer: Kentucky WC Medicaid |
$183.61
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$433.39
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$390.05
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$158.56
|
Rate for Payer: Molina Healthcare Medicaid |
$185.40
|
Rate for Payer: Ohio Health Choice Commercial |
$465.10
|
Rate for Payer: Ohio Health Group HMO |
$396.39
|
Rate for Payer: Ohio Health Group PPO Differential |
$105.70
|
Rate for Payer: Ohio Health Group PPO No Differential |
$68.71
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.84
|
Rate for Payer: PHCS Commercial |
$507.38
|
Rate for Payer: United Healthcare All Payer |
$465.10
|
|
GASTROINTESTINAL HEMORRHAGE WITH CC
|
Facility
|
IP
|
$11,508.70
|
|
Service Code
|
MSDRG 378
|
Min. Negotiated Rate |
$7,809.48 |
Max. Negotiated Rate |
$11,508.70 |
Rate for Payer: Anthem Medicaid |
$7,809.48
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$8,220.50
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,508.70
|
Rate for Payer: CareSource Just4Me Medicare |
$11,097.68
|
Rate for Payer: Humana KY Medicaid |
$7,809.48
|
Rate for Payer: Humana Medicare Advantage |
$8,220.50
|
Rate for Payer: Kentucky WC Medicaid |
$7,887.57
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$9,864.60
|
Rate for Payer: Molina Healthcare Medicaid |
$7,965.66
|
|
GASTROINTESTINAL HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$20,943.30
|
|
Service Code
|
MSDRG 377
|
Min. Negotiated Rate |
$14,211.52 |
Max. Negotiated Rate |
$20,943.30 |
Rate for Payer: Anthem Medicaid |
$14,211.52
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$14,959.50
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,943.30
|
Rate for Payer: CareSource Just4Me Medicare |
$20,195.32
|
Rate for Payer: Humana KY Medicaid |
$14,211.52
|
Rate for Payer: Humana Medicare Advantage |
$14,959.50
|
Rate for Payer: Kentucky WC Medicaid |
$14,353.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$17,951.40
|
Rate for Payer: Molina Healthcare Medicaid |
$14,495.76
|
|