Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

SIGMOIDOSCOPY - FLEXIBLE; DIA

Facility

$173.00

Service Code	HCPCS 45330
Hospital Charge Code	76101882
Hospital Revenue Code	761
Min. Negotiated Rate	$22.49
Max. Negotiated Rate	$166.08
Rate for Payer: Aetna Commercial	$133.21
Rate for Payer: Anthem POS/PPO/Traditional	$134.94
Rate for Payer: Cash Price	$86.50
Rate for Payer: Cigna Commercial	$143.59
Rate for Payer: First Health Commercial	$164.35
Rate for Payer: Humana Commercial	$147.05
Rate for Payer: Medical Mutual Of Ohio HMO	$141.86
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$127.67
Rate for Payer: Molina Healthcare Benefit Exchange	$51.90
Rate for Payer: Ohio Health Choice Commercial	$152.24
Rate for Payer: Ohio Health Group HMO	$129.75
Rate for Payer: Ohio Health Group PPO Differential	$34.60
Rate for Payer: Ohio Health Group PPO No Differential	$22.49
Rate for Payer: Ohio Health Group PPO SOMC Employees	$53.63
Rate for Payer: PHCS Commercial	$166.08
Rate for Payer: United Healthcare All Payer	$152.24

SIGMOIDOSCOPY - FLEXIBLE; DIA

Facility

$173.00

Service Code	HCPCS 45330
Hospital Charge Code	76101882
Hospital Revenue Code	761
Min. Negotiated Rate	$22.49
Max. Negotiated Rate	$1,106.49
Rate for Payer: Aetna Commercial	$133.21
Rate for Payer: Anthem Medicaid	$59.49
Rate for Payer: Anthem Medicare Advantage/PPO	$790.35
Rate for Payer: Anthem POS/PPO/Traditional	$134.94
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,106.49
Rate for Payer: CareSource Just4Me Medicare	$1,066.97
Rate for Payer: Cash Price	$86.50
Rate for Payer: Cash Price	$86.50
Rate for Payer: Cigna Commercial	$143.59
Rate for Payer: First Health Commercial	$164.35
Rate for Payer: Humana Commercial	$147.05
Rate for Payer: Humana KY Medicaid	$59.49
Rate for Payer: Humana Medicare Advantage	$790.35
Rate for Payer: Kentucky WC Medicaid	$60.10
Rate for Payer: Medical Mutual Of Ohio HMO	$141.86
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$127.67
Rate for Payer: Molina Healthcare Benefit Exchange	$948.42
Rate for Payer: Molina Healthcare Medicaid	$60.69
Rate for Payer: Ohio Health Choice Commercial	$152.24
Rate for Payer: Ohio Health Group HMO	$129.75
Rate for Payer: Ohio Health Group PPO Differential	$34.60
Rate for Payer: Ohio Health Group PPO No Differential	$22.49
Rate for Payer: Ohio Health Group PPO SOMC Employees	$53.63
Rate for Payer: PHCS Commercial	$166.08
Rate for Payer: United Healthcare All Payer	$152.24

SIGMOIDOSCOPY - FLEXIBLE; DIA

Professional

Both

$173.00

Service Code	HCPCS 45330
Hospital Charge Code	76101882
Hospital Revenue Code	761
Min. Negotiated Rate	$47.58
Max. Negotiated Rate	$183.79
Rate for Payer: Aetna Commercial	$93.23
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$52.42
Rate for Payer: Anthem Medicaid	$47.58
Rate for Payer: Buckeye Medicare Advantage	$173.00
Rate for Payer: Cash Price	$86.50
Rate for Payer: Cash Price	$86.50
Rate for Payer: Cigna Commercial	$183.79
Rate for Payer: Healthspan PPO	$161.22
Rate for Payer: Humana Medicaid	$47.58
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$80.76
Rate for Payer: Molina Healthcare CHIP/Medicaid	$48.53
Rate for Payer: Molina Healthcare Passport	$47.58
Rate for Payer: Multiplan PHCS	$103.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$121.10
Rate for Payer: UHCCP Medicaid	$55.04
Rate for Payer: Wellcare CHIP/Medicaid	$48.06

SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$1,106.49

Service Code	CPT 45330
Hospital Revenue Code	360
Min. Negotiated Rate	$790.35
Max. Negotiated Rate	$1,106.49
Rate for Payer: Anthem Medicare Advantage/PPO	$790.35
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,106.49
Rate for Payer: CareSource Just4Me Medicare	$1,066.97
Rate for Payer: Humana Medicare Advantage	$790.35
Rate for Payer: Molina Healthcare Benefit Exchange	$948.42

SIGMOIDOSCOPY - FLEXIBLE; DI(P

Professional

Both

$173.00

Service Code	HCPCS 45330
Hospital Charge Code	761P1882
Hospital Revenue Code	761
Min. Negotiated Rate	$47.58
Max. Negotiated Rate	$183.79
Rate for Payer: Aetna Commercial	$93.23
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$52.42
Rate for Payer: Anthem Medicaid	$47.58
Rate for Payer: Buckeye Medicare Advantage	$173.00
Rate for Payer: Cash Price	$86.50
Rate for Payer: Cash Price	$86.50
Rate for Payer: Cigna Commercial	$183.79
Rate for Payer: Healthspan PPO	$161.22
Rate for Payer: Humana Medicaid	$47.58
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$80.76
Rate for Payer: Molina Healthcare CHIP/Medicaid	$48.53
Rate for Payer: Molina Healthcare Passport	$47.58
Rate for Payer: Multiplan PHCS	$103.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$121.10
Rate for Payer: UHCCP Medicaid	$55.04
Rate for Payer: Wellcare CHIP/Medicaid	$48.06

SIGMOIDOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)

Facility

$1,428.66

Service Code	CPT 45350
Hospital Revenue Code	360
Min. Negotiated Rate	$1,020.47
Max. Negotiated Rate	$1,428.66
Rate for Payer: Anthem Medicare Advantage/PPO	$1,020.47
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,428.66
Rate for Payer: CareSource Just4Me Medicare	$1,377.63
Rate for Payer: Humana Medicare Advantage	$1,020.47
Rate for Payer: Molina Healthcare Benefit Exchange	$1,224.56

SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$1,106.49

Service Code	CPT 45331
Hospital Revenue Code	360
Min. Negotiated Rate	$790.35
Max. Negotiated Rate	$1,106.49
Rate for Payer: Anthem Medicare Advantage/PPO	$790.35
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,106.49
Rate for Payer: CareSource Just4Me Medicare	$1,066.97
Rate for Payer: Humana Medicare Advantage	$790.35
Rate for Payer: Molina Healthcare Benefit Exchange	$948.42

SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD

Facility

$1,428.66

Service Code	CPT 45334
Hospital Revenue Code	360
Min. Negotiated Rate	$1,020.47
Max. Negotiated Rate	$1,428.66
Rate for Payer: Anthem Medicare Advantage/PPO	$1,020.47
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,428.66
Rate for Payer: CareSource Just4Me Medicare	$1,377.63
Rate for Payer: Humana Medicare Advantage	$1,020.47
Rate for Payer: Molina Healthcare Benefit Exchange	$1,224.56

SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE

Facility

$1,106.49

Service Code	CPT 45335
Hospital Revenue Code	360
Min. Negotiated Rate	$790.35
Max. Negotiated Rate	$1,106.49
Rate for Payer: Anthem Medicare Advantage/PPO	$790.35
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,106.49
Rate for Payer: CareSource Just4Me Medicare	$1,066.97
Rate for Payer: Humana Medicare Advantage	$790.35
Rate for Payer: Molina Healthcare Benefit Exchange	$948.42

SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$1,428.66

Service Code	CPT 45338
Hospital Revenue Code	360
Min. Negotiated Rate	$1,020.47
Max. Negotiated Rate	$1,428.66
Rate for Payer: Anthem Medicare Advantage/PPO	$1,020.47
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,428.66
Rate for Payer: CareSource Just4Me Medicare	$1,377.63
Rate for Payer: Humana Medicare Advantage	$1,020.47
Rate for Payer: Molina Healthcare Benefit Exchange	$1,224.56

SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC BALLOON DILATION

Facility

$1,428.66

Service Code	CPT 45340
Hospital Revenue Code	360
Min. Negotiated Rate	$1,020.47
Max. Negotiated Rate	$1,428.66
Rate for Payer: Anthem Medicare Advantage/PPO	$1,020.47
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,428.66
Rate for Payer: CareSource Just4Me Medicare	$1,377.63
Rate for Payer: Humana Medicare Advantage	$1,020.47
Rate for Payer: Molina Healthcare Benefit Exchange	$1,224.56

SIGMOIDOSCOPY FOR BLEEDING

Facility

$800.00

Service Code	HCPCS 45334
Hospital Charge Code	76101884
Hospital Revenue Code	761
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$768.00
Rate for Payer: Aetna Commercial	$616.00
Rate for Payer: Anthem POS/PPO/Traditional	$624.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cigna Commercial	$664.00
Rate for Payer: First Health Commercial	$760.00
Rate for Payer: Humana Commercial	$680.00
Rate for Payer: Medical Mutual Of Ohio HMO	$656.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$590.40
Rate for Payer: Molina Healthcare Benefit Exchange	$240.00
Rate for Payer: Ohio Health Choice Commercial	$704.00
Rate for Payer: Ohio Health Group HMO	$600.00
Rate for Payer: Ohio Health Group PPO Differential	$160.00
Rate for Payer: Ohio Health Group PPO No Differential	$104.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$248.00
Rate for Payer: PHCS Commercial	$768.00
Rate for Payer: United Healthcare All Payer	$704.00

SIGMOIDOSCOPY FOR BLEEDING

Facility

$800.00

Service Code	HCPCS 45334
Hospital Charge Code	76101884
Hospital Revenue Code	761
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$1,428.66
Rate for Payer: Aetna Commercial	$616.00
Rate for Payer: Anthem Medicaid	$275.12
Rate for Payer: Anthem Medicare Advantage/PPO	$1,020.47
Rate for Payer: Anthem POS/PPO/Traditional	$624.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,428.66
Rate for Payer: CareSource Just4Me Medicare	$1,377.63
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cigna Commercial	$664.00
Rate for Payer: First Health Commercial	$760.00
Rate for Payer: Humana Commercial	$680.00
Rate for Payer: Humana KY Medicaid	$275.12
Rate for Payer: Humana Medicare Advantage	$1,020.47
Rate for Payer: Kentucky WC Medicaid	$277.92
Rate for Payer: Medical Mutual Of Ohio HMO	$656.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$590.40
Rate for Payer: Molina Healthcare Benefit Exchange	$1,224.56
Rate for Payer: Molina Healthcare Medicaid	$280.64
Rate for Payer: Ohio Health Choice Commercial	$704.00
Rate for Payer: Ohio Health Group HMO	$600.00
Rate for Payer: Ohio Health Group PPO Differential	$160.00
Rate for Payer: Ohio Health Group PPO No Differential	$104.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$248.00
Rate for Payer: PHCS Commercial	$768.00
Rate for Payer: United Healthcare All Payer	$704.00

SIGMOIDOSCOPY FOR BLEEDING

Professional

Both

$800.00

Service Code	HCPCS 45334
Hospital Charge Code	76101884
Hospital Revenue Code	761
Min. Negotiated Rate	$119.05
Max. Negotiated Rate	$800.00
Rate for Payer: Aetna Commercial	$249.98
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$119.05
Rate for Payer: Anthem Medicaid	$166.01
Rate for Payer: Buckeye Medicare Advantage	$800.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cigna Commercial	$224.95
Rate for Payer: Healthspan PPO	$210.82
Rate for Payer: Humana Medicaid	$166.01
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$213.78
Rate for Payer: Molina Healthcare CHIP/Medicaid	$169.33
Rate for Payer: Molina Healthcare Passport	$166.01
Rate for Payer: Multiplan PHCS	$480.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$560.00
Rate for Payer: UHCCP Medicaid	$125.00
Rate for Payer: Wellcare CHIP/Medicaid	$167.67

SIGMOIDOSCOPY FOR BLEEDING(P

Professional

Both

$800.00

Service Code	HCPCS 45334
Hospital Charge Code	761P1884
Hospital Revenue Code	761
Min. Negotiated Rate	$119.05
Max. Negotiated Rate	$800.00
Rate for Payer: Aetna Commercial	$249.98
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$119.05
Rate for Payer: Anthem Medicaid	$166.01
Rate for Payer: Buckeye Medicare Advantage	$800.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cigna Commercial	$224.95
Rate for Payer: Healthspan PPO	$210.82
Rate for Payer: Humana Medicaid	$166.01
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$213.78
Rate for Payer: Molina Healthcare CHIP/Medicaid	$169.33
Rate for Payer: Molina Healthcare Passport	$166.01
Rate for Payer: Multiplan PHCS	$480.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$560.00
Rate for Payer: UHCCP Medicaid	$125.00
Rate for Payer: Wellcare CHIP/Medicaid	$167.67

SIGMOIDOSCOPY W BIOPSY

Facility

$350.00

Service Code	HCPCS 45331
Hospital Charge Code	76101883
Hospital Revenue Code	761
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$1,106.49
Rate for Payer: Aetna Commercial	$269.50
Rate for Payer: Anthem Medicaid	$120.36
Rate for Payer: Anthem Medicare Advantage/PPO	$790.35
Rate for Payer: Anthem POS/PPO/Traditional	$273.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,106.49
Rate for Payer: CareSource Just4Me Medicare	$1,066.97
Rate for Payer: Cash Price	$175.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Cigna Commercial	$290.50
Rate for Payer: First Health Commercial	$332.50
Rate for Payer: Humana Commercial	$297.50
Rate for Payer: Humana KY Medicaid	$120.36
Rate for Payer: Humana Medicare Advantage	$790.35
Rate for Payer: Kentucky WC Medicaid	$121.59
Rate for Payer: Medical Mutual Of Ohio HMO	$287.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$258.30
Rate for Payer: Molina Healthcare Benefit Exchange	$948.42
Rate for Payer: Molina Healthcare Medicaid	$122.78
Rate for Payer: Ohio Health Choice Commercial	$308.00
Rate for Payer: Ohio Health Group HMO	$262.50
Rate for Payer: Ohio Health Group PPO Differential	$70.00
Rate for Payer: Ohio Health Group PPO No Differential	$45.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$108.50
Rate for Payer: PHCS Commercial	$336.00
Rate for Payer: United Healthcare All Payer	$308.00

SIGMOIDOSCOPY W BIOPSY

Professional

Both

$350.00

Service Code	HCPCS 45331
Hospital Charge Code	76101883
Hospital Revenue Code	761
Min. Negotiated Rate	$63.50
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$112.94
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$63.50
Rate for Payer: Anthem Medicaid	$83.80
Rate for Payer: Buckeye Medicare Advantage	$350.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Cigna Commercial	$101.20
Rate for Payer: Healthspan PPO	$204.47
Rate for Payer: Humana Medicaid	$83.80
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$98.22
Rate for Payer: Molina Healthcare CHIP/Medicaid	$85.48
Rate for Payer: Molina Healthcare Passport	$83.80
Rate for Payer: Multiplan PHCS	$210.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$245.00
Rate for Payer: UHCCP Medicaid	$66.68
Rate for Payer: Wellcare CHIP/Medicaid	$84.64

SIGMOIDOSCOPY W BIOPSY

Facility

$350.00

Service Code	HCPCS 45331
Hospital Charge Code	76101883
Hospital Revenue Code	761
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$336.00
Rate for Payer: Aetna Commercial	$269.50
Rate for Payer: Anthem POS/PPO/Traditional	$273.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Cigna Commercial	$290.50
Rate for Payer: First Health Commercial	$332.50
Rate for Payer: Humana Commercial	$297.50
Rate for Payer: Medical Mutual Of Ohio HMO	$287.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$258.30
Rate for Payer: Molina Healthcare Benefit Exchange	$105.00
Rate for Payer: Ohio Health Choice Commercial	$308.00
Rate for Payer: Ohio Health Group HMO	$262.50
Rate for Payer: Ohio Health Group PPO Differential	$70.00
Rate for Payer: Ohio Health Group PPO No Differential	$45.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$108.50
Rate for Payer: PHCS Commercial	$336.00
Rate for Payer: United Healthcare All Payer	$308.00

SIGMOIDOSCOPY W BIOPSY(P

Professional

Both

$350.00

Service Code	HCPCS 45331
Hospital Charge Code	761P1883
Hospital Revenue Code	761
Min. Negotiated Rate	$63.50
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$112.94
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$63.50
Rate for Payer: Anthem Medicaid	$83.80
Rate for Payer: Buckeye Medicare Advantage	$350.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Cigna Commercial	$101.20
Rate for Payer: Healthspan PPO	$204.47
Rate for Payer: Humana Medicaid	$83.80
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$98.22
Rate for Payer: Molina Healthcare CHIP/Medicaid	$85.48
Rate for Payer: Molina Healthcare Passport	$83.80
Rate for Payer: Multiplan PHCS	$210.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$245.00
Rate for Payer: UHCCP Medicaid	$66.68
Rate for Payer: Wellcare CHIP/Medicaid	$84.64

SIGMOIDOSCOPY W/PLCMT STENT

Professional

Both

$300.00

Service Code	HCPCS 45347
Hospital Charge Code	76101889
Hospital Revenue Code	761
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$300.00
Rate for Payer: Anthem Medicaid	$131.18
Rate for Payer: Buckeye Medicare Advantage	$300.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cigna Commercial	$275.71
Rate for Payer: Humana Medicaid	$131.18
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$227.15
Rate for Payer: Molina Healthcare CHIP/Medicaid	$133.80
Rate for Payer: Molina Healthcare Passport	$131.18
Rate for Payer: Multiplan PHCS	$180.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$210.00
Rate for Payer: UHCCP Medicaid	$105.00
Rate for Payer: Wellcare CHIP/Medicaid	$132.49

SIGMOIDOSCOPY W/PLCMT STENT

Facility

$300.00

Service Code	HCPCS 45347
Hospital Charge Code	76101889
Hospital Revenue Code	761
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna Commercial	$231.00
Rate for Payer: Anthem POS/PPO/Traditional	$234.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: First Health Commercial	$285.00
Rate for Payer: Humana Commercial	$255.00
Rate for Payer: Medical Mutual Of Ohio HMO	$246.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$221.40
Rate for Payer: Molina Healthcare Benefit Exchange	$90.00
Rate for Payer: Ohio Health Choice Commercial	$264.00
Rate for Payer: Ohio Health Group HMO	$225.00
Rate for Payer: Ohio Health Group PPO Differential	$60.00
Rate for Payer: Ohio Health Group PPO No Differential	$39.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$93.00
Rate for Payer: PHCS Commercial	$288.00
Rate for Payer: United Healthcare All Payer	$264.00

SIGMOIDOSCOPY W/PLCMT STENT

Facility

$300.00

Service Code	HCPCS 45347
Hospital Charge Code	76101889
Hospital Revenue Code	761
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$6,899.82
Rate for Payer: Aetna Commercial	$231.00
Rate for Payer: Anthem Medicaid	$103.17
Rate for Payer: Anthem Medicare Advantage/PPO	$4,928.44
Rate for Payer: Anthem POS/PPO/Traditional	$234.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$6,899.82
Rate for Payer: CareSource Just4Me Medicare	$6,653.39
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: First Health Commercial	$285.00
Rate for Payer: Humana Commercial	$255.00
Rate for Payer: Humana KY Medicaid	$103.17
Rate for Payer: Humana Medicare Advantage	$4,928.44
Rate for Payer: Kentucky WC Medicaid	$104.22
Rate for Payer: Medical Mutual Of Ohio HMO	$246.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$221.40
Rate for Payer: Molina Healthcare Benefit Exchange	$5,914.13
Rate for Payer: Molina Healthcare Medicaid	$105.24
Rate for Payer: Ohio Health Choice Commercial	$264.00
Rate for Payer: Ohio Health Group HMO	$225.00
Rate for Payer: Ohio Health Group PPO Differential	$60.00
Rate for Payer: Ohio Health Group PPO No Differential	$39.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$93.00
Rate for Payer: PHCS Commercial	$288.00
Rate for Payer: United Healthcare All Payer	$264.00

SIGMOIDOSCOPY W/PLCMT STENT(P

Professional

Both

$300.00

Service Code	HCPCS 45347
Hospital Charge Code	761P1889
Hospital Revenue Code	761
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$300.00
Rate for Payer: Anthem Medicaid	$131.18
Rate for Payer: Buckeye Medicare Advantage	$300.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cigna Commercial	$275.71
Rate for Payer: Humana Medicaid	$131.18
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$227.15
Rate for Payer: Molina Healthcare CHIP/Medicaid	$133.80
Rate for Payer: Molina Healthcare Passport	$131.18
Rate for Payer: Multiplan PHCS	$180.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$210.00
Rate for Payer: UHCCP Medicaid	$105.00
Rate for Payer: Wellcare CHIP/Medicaid	$132.49

SIGMOIDOSCOPY W/SUBMUC INJ

Facility

$720.00

Service Code	HCPCS 45335
Hospital Charge Code	76101885
Hospital Revenue Code	761
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$1,106.49
Rate for Payer: Aetna Commercial	$554.40
Rate for Payer: Anthem Medicaid	$247.61
Rate for Payer: Anthem Medicare Advantage/PPO	$790.35
Rate for Payer: Anthem POS/PPO/Traditional	$561.60
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,106.49
Rate for Payer: CareSource Just4Me Medicare	$1,066.97
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cigna Commercial	$597.60
Rate for Payer: First Health Commercial	$684.00
Rate for Payer: Humana Commercial	$612.00
Rate for Payer: Humana KY Medicaid	$247.61
Rate for Payer: Humana Medicare Advantage	$790.35
Rate for Payer: Kentucky WC Medicaid	$250.13
Rate for Payer: Medical Mutual Of Ohio HMO	$590.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$531.36
Rate for Payer: Molina Healthcare Benefit Exchange	$948.42
Rate for Payer: Molina Healthcare Medicaid	$252.58
Rate for Payer: Ohio Health Choice Commercial	$633.60
Rate for Payer: Ohio Health Group HMO	$540.00
Rate for Payer: Ohio Health Group PPO Differential	$144.00
Rate for Payer: Ohio Health Group PPO No Differential	$93.60
Rate for Payer: Ohio Health Group PPO SOMC Employees	$223.20
Rate for Payer: PHCS Commercial	$691.20
Rate for Payer: United Healthcare All Payer	$633.60

SIGMOIDOSCOPY W/SUBMUC INJ

Professional

Both

$720.00

Service Code	HCPCS 45335
Hospital Charge Code	76101885
Hospital Revenue Code	761
Min. Negotiated Rate	$57.66
Max. Negotiated Rate	$720.00
Rate for Payer: Aetna Commercial	$137.61
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$66.79
Rate for Payer: Anthem Medicaid	$57.66
Rate for Payer: Buckeye Medicare Advantage	$720.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cigna Commercial	$124.92
Rate for Payer: Healthspan PPO	$288.02
Rate for Payer: Humana Medicaid	$57.66
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$119.74
Rate for Payer: Molina Healthcare CHIP/Medicaid	$58.81
Rate for Payer: Molina Healthcare Passport	$57.66
Rate for Payer: Multiplan PHCS	$432.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$504.00
Rate for Payer: UHCCP Medicaid	$70.13
Rate for Payer: Wellcare CHIP/Medicaid	$58.24

Know your out-of-pocket cost for care.

All Charges