|
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$7,407.32
|
|
|
Service Code
|
MSDRG 379
|
| Min. Negotiated Rate |
$5,026.39 |
| Max. Negotiated Rate |
$7,407.32 |
| Rate for Payer: Anthem Medicaid |
$5,026.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,290.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,407.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,142.77
|
| Rate for Payer: Humana KY Medicaid |
$5,026.39
|
| Rate for Payer: Humana Medicare Advantage |
$5,290.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,076.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,349.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,126.92
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH CC
|
Facility
|
IP
|
$9,316.47
|
|
|
Service Code
|
MSDRG 389
|
| Min. Negotiated Rate |
$6,321.89 |
| Max. Negotiated Rate |
$9,316.47 |
| Rate for Payer: Anthem Medicaid |
$6,321.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,654.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,316.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,983.74
|
| Rate for Payer: Humana KY Medicaid |
$6,321.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,654.62
|
| Rate for Payer: Kentucky WC Medicaid |
$6,385.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,985.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,448.33
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH MCC
|
Facility
|
IP
|
$17,003.35
|
|
|
Service Code
|
MSDRG 388
|
| Min. Negotiated Rate |
$11,537.99 |
| Max. Negotiated Rate |
$17,003.35 |
| Rate for Payer: Anthem Medicaid |
$11,537.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,145.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,003.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,396.09
|
| Rate for Payer: Humana KY Medicaid |
$11,537.99
|
| Rate for Payer: Humana Medicare Advantage |
$12,145.25
|
| Rate for Payer: Kentucky WC Medicaid |
$11,653.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,574.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,768.75
|
|
|
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$6,539.30
|
|
|
Service Code
|
MSDRG 390
|
| Min. Negotiated Rate |
$4,437.38 |
| Max. Negotiated Rate |
$6,539.30 |
| Rate for Payer: Anthem Medicaid |
$4,437.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,670.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,539.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,305.76
|
| Rate for Payer: Humana KY Medicaid |
$4,437.38
|
| Rate for Payer: Humana Medicare Advantage |
$4,670.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,481.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,605.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,526.13
|
|
|
GASTRO JEGUNAL KIT
|
Facility
|
OP
|
$1,954.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,876.61 |
| Rate for Payer: Aetna Commercial |
$1,505.20
|
| Rate for Payer: Anthem Medicaid |
$672.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,524.74
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cigna Commercial |
$1,622.48
|
| Rate for Payer: First Health Commercial |
$1,857.06
|
| Rate for Payer: Humana Commercial |
$1,661.58
|
| Rate for Payer: Humana KY Medicaid |
$672.26
|
| Rate for Payer: Kentucky WC Medicaid |
$679.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,602.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,442.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,720.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,466.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.99
|
| Rate for Payer: PHCS Commercial |
$1,876.61
|
| Rate for Payer: United Healthcare All Payer |
$1,720.22
|
|
|
GASTRO JEGUNAL KIT
|
Facility
|
IP
|
$1,954.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,876.61 |
| Rate for Payer: Aetna Commercial |
$1,505.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,524.74
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cigna Commercial |
$1,622.48
|
| Rate for Payer: First Health Commercial |
$1,857.06
|
| Rate for Payer: Humana Commercial |
$1,661.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,602.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,442.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,720.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,466.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.99
|
| Rate for Payer: PHCS Commercial |
$1,876.61
|
| Rate for Payer: United Healthcare All Payer |
$1,720.22
|
|
|
GASTROSTOMY, OPEN; WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,303.66
|
|
|
Service Code
|
CPT 43830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.47 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
|
|
GASTROSTOMY OPEN WO GASTRCTUBE
|
Professional
|
Both
|
$1,810.00
|
|
|
Service Code
|
HCPCS 43830
|
| Hospital Charge Code |
76101797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.97 |
| Max. Negotiated Rate |
$1,810.00 |
| Rate for Payer: Aetna Commercial |
$988.43
|
| Rate for Payer: Anthem Medicaid |
$336.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,810.00
|
| Rate for Payer: Cash Price |
$905.00
|
| Rate for Payer: Cash Price |
$905.00
|
| Rate for Payer: Cigna Commercial |
$913.61
|
| Rate for Payer: Healthspan PPO |
$833.56
|
| Rate for Payer: Humana Medicaid |
$336.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$343.71
|
| Rate for Payer: Molina Healthcare Passport |
$336.97
|
| Rate for Payer: Multiplan PHCS |
$1,086.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,267.00
|
| Rate for Payer: UHCCP Medicaid |
$633.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$340.34
|
|
|
GASTROSTOMY OPEN WO GASTRCTUBE
|
Facility
|
IP
|
$1,810.00
|
|
|
Service Code
|
HCPCS 43830
|
| Hospital Charge Code |
76101797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.30 |
| Max. Negotiated Rate |
$1,737.60 |
| Rate for Payer: Aetna Commercial |
$1,393.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.80
|
| Rate for Payer: Cash Price |
$905.00
|
| Rate for Payer: Cigna Commercial |
$1,502.30
|
| Rate for Payer: First Health Commercial |
$1,719.50
|
| Rate for Payer: Humana Commercial |
$1,538.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,484.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,592.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,357.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.10
|
| Rate for Payer: PHCS Commercial |
$1,737.60
|
| Rate for Payer: United Healthcare All Payer |
$1,592.80
|
|
|
GASTROSTOMY OPEN WO GASTRCTUBE
|
Professional
|
Both
|
$1,810.00
|
|
|
Service Code
|
HCPCS 43830
|
| Hospital Charge Code |
761P1797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.97 |
| Max. Negotiated Rate |
$1,810.00 |
| Rate for Payer: Aetna Commercial |
$988.43
|
| Rate for Payer: Anthem Medicaid |
$336.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,810.00
|
| Rate for Payer: Cash Price |
$905.00
|
| Rate for Payer: Cash Price |
$905.00
|
| Rate for Payer: Cigna Commercial |
$913.61
|
| Rate for Payer: Healthspan PPO |
$833.56
|
| Rate for Payer: Humana Medicaid |
$336.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$343.71
|
| Rate for Payer: Molina Healthcare Passport |
$336.97
|
| Rate for Payer: Multiplan PHCS |
$1,086.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,267.00
|
| Rate for Payer: UHCCP Medicaid |
$633.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$340.34
|
|
|
GASTROSTOMY OPEN WO GASTRCTUBE
|
Facility
|
OP
|
$1,810.00
|
|
|
Service Code
|
HCPCS 43830
|
| Hospital Charge Code |
76101797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.30 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$1,393.70
|
| Rate for Payer: Anthem Medicaid |
$622.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$905.00
|
| Rate for Payer: Cash Price |
$905.00
|
| Rate for Payer: Cigna Commercial |
$1,502.30
|
| Rate for Payer: First Health Commercial |
$1,719.50
|
| Rate for Payer: Humana Commercial |
$1,538.50
|
| Rate for Payer: Humana KY Medicaid |
$622.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$628.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,484.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,592.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,357.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.10
|
| Rate for Payer: PHCS Commercial |
$1,737.60
|
| Rate for Payer: United Healthcare All Payer |
$1,592.80
|
|
|
GASTROTOMY REMV FOREIGN BODY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 43500
|
| Hospital Charge Code |
76101779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.59 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,121.69
|
| Rate for Payer: Anthem Medicaid |
$416.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,034.93
|
| Rate for Payer: Healthspan PPO |
$945.94
|
| Rate for Payer: Humana Medicaid |
$416.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,000.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$424.92
|
| Rate for Payer: Molina Healthcare Passport |
$416.59
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$420.76
|
|
|
GASTROTOMY REMV FOREIGN BODY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 43500
|
| Hospital Charge Code |
76101779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
GASTROTOMY REMV FOREIGN BODY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 43500
|
| Hospital Charge Code |
76101779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
GASTROTOMY REMV FOREIGN BODY(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 43500
|
| Hospital Charge Code |
761P1779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.59 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,121.69
|
| Rate for Payer: Anthem Medicaid |
$416.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,034.93
|
| Rate for Payer: Healthspan PPO |
$945.94
|
| Rate for Payer: Humana Medicaid |
$416.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,000.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$424.92
|
| Rate for Payer: Molina Healthcare Passport |
$416.59
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$420.76
|
|
|
GASTROTOMY ULCER REPR
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43501
|
| Hospital Charge Code |
76101780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
GASTROTOMY ULCER REPR
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43501
|
| Hospital Charge Code |
76101780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
GASTROTOMY ULCER REPR
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43501
|
| Hospital Charge Code |
76101780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$681.01 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,936.48
|
| Rate for Payer: Anthem Medicaid |
$681.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,798.86
|
| Rate for Payer: Healthspan PPO |
$1,633.07
|
| Rate for Payer: Humana Medicaid |
$681.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,716.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$694.63
|
| Rate for Payer: Molina Healthcare Passport |
$681.01
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$687.82
|
|
|
GASTROTOMY ULCER REPR(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43501
|
| Hospital Charge Code |
761P1780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$681.01 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,936.48
|
| Rate for Payer: Anthem Medicaid |
$681.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,798.86
|
| Rate for Payer: Healthspan PPO |
$1,633.07
|
| Rate for Payer: Humana Medicaid |
$681.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,716.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$694.63
|
| Rate for Payer: Molina Healthcare Passport |
$681.01
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$687.82
|
|
|
GATED HEART PLANAR SINGLE
|
Facility
|
IP
|
$1,693.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
34000020
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$220.09 |
| Max. Negotiated Rate |
$1,625.28 |
| Rate for Payer: Aetna Commercial |
$1,303.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,320.54
|
| Rate for Payer: Cash Price |
$846.50
|
| Rate for Payer: Cigna Commercial |
$1,405.19
|
| Rate for Payer: First Health Commercial |
$1,608.35
|
| Rate for Payer: Humana Commercial |
$1,439.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,388.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,249.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,489.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,269.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$338.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$524.83
|
| Rate for Payer: PHCS Commercial |
$1,625.28
|
| Rate for Payer: United Healthcare All Payer |
$1,489.84
|
|
|
GATED HEART PLANAR SINGLE
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
34000020
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,693.00 |
| Rate for Payer: Aetna Commercial |
$396.01
|
| Rate for Payer: Anthem Medicaid |
$191.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,693.00
|
| Rate for Payer: Cash Price |
$846.50
|
| Rate for Payer: Cash Price |
$846.50
|
| Rate for Payer: Cigna Commercial |
$394.92
|
| Rate for Payer: Healthspan PPO |
$395.81
|
| Rate for Payer: Humana Medicaid |
$191.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.17
|
| Rate for Payer: Molina Healthcare Passport |
$191.34
|
| Rate for Payer: Multiplan PHCS |
$1,015.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,185.10
|
| Rate for Payer: UHCCP Medicaid |
$592.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.25
|
|
|
GATED HEART PLANAR SINGLE
|
Facility
|
OP
|
$1,693.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
34000020
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$220.09 |
| Max. Negotiated Rate |
$1,625.28 |
| Rate for Payer: Aetna Commercial |
$1,303.61
|
| Rate for Payer: Anthem Medicaid |
$582.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,320.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$846.50
|
| Rate for Payer: Cash Price |
$846.50
|
| Rate for Payer: Cigna Commercial |
$1,405.19
|
| Rate for Payer: First Health Commercial |
$1,608.35
|
| Rate for Payer: Humana Commercial |
$1,439.05
|
| Rate for Payer: Humana KY Medicaid |
$582.22
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$588.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,388.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,249.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$593.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,489.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,269.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$338.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$524.83
|
| Rate for Payer: PHCS Commercial |
$1,625.28
|
| Rate for Payer: United Healthcare All Payer |
$1,489.84
|
|
|
GATED HEART PLANAR SINGLE(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
340P0020
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$396.01 |
| Rate for Payer: Aetna Commercial |
$396.01
|
| Rate for Payer: Anthem Medicaid |
$191.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$394.92
|
| Rate for Payer: Healthspan PPO |
$395.81
|
| Rate for Payer: Humana Medicaid |
$191.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.17
|
| Rate for Payer: Molina Healthcare Passport |
$191.34
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.25
|
|
|
GATED HEART PLANAR SINGLE(T
|
Facility
|
IP
|
$1,518.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
340T0020
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$197.34 |
| Max. Negotiated Rate |
$1,457.28 |
| Rate for Payer: Aetna Commercial |
$1,168.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.04
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,259.94
|
| Rate for Payer: First Health Commercial |
$1,442.10
|
| Rate for Payer: Humana Commercial |
$1,290.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,244.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,120.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,335.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,138.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$470.58
|
| Rate for Payer: PHCS Commercial |
$1,457.28
|
| Rate for Payer: United Healthcare All Payer |
$1,335.84
|
|
|
GATED HEART PLANAR SINGLE(T
|
Facility
|
OP
|
$1,518.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
340T0020
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$197.34 |
| Max. Negotiated Rate |
$1,457.28 |
| Rate for Payer: Aetna Commercial |
$1,168.86
|
| Rate for Payer: Anthem Medicaid |
$522.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,259.94
|
| Rate for Payer: First Health Commercial |
$1,442.10
|
| Rate for Payer: Humana Commercial |
$1,290.30
|
| Rate for Payer: Humana KY Medicaid |
$522.04
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$527.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,244.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,120.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$532.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,335.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,138.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$470.58
|
| Rate for Payer: PHCS Commercial |
$1,457.28
|
| Rate for Payer: United Healthcare All Payer |
$1,335.84
|
|
