|
SIGMA TPR STEM CEM 13MM*90MM
|
Facility
|
IP
|
$8,931.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,679.38 |
| Max. Negotiated Rate |
$8,574.00 |
| Rate for Payer: Aetna Commercial |
$6,877.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.38
|
| Rate for Payer: Cash Price |
$4,465.62
|
| Rate for Payer: Cigna Commercial |
$7,412.94
|
| Rate for Payer: First Health Commercial |
$8,484.69
|
| Rate for Payer: Humana Commercial |
$7,591.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,770.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,162.56
|
| Rate for Payer: PHCS Commercial |
$8,574.00
|
| Rate for Payer: United Healthcare All Payer |
$7,859.50
|
|
|
SIGMOIDOSCOPY & DECOMPRESS
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 45337
|
| Hospital Charge Code |
76101886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.35
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
SIGMOIDOSCOPY & DECOMPRESS
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 45337
|
| Hospital Charge Code |
76101886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.89 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem Medicaid |
$245.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Humana KY Medicaid |
$245.89
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$248.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.35
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
SIGMOIDOSCOPY & DECOMPRESS
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 45337
|
| Hospital Charge Code |
76101886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.01 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Ambetter Exchange |
$107.01
|
| Rate for Payer: Anthem Medicaid |
$159.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$107.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.41
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$195.53
|
| Rate for Payer: Healthspan PPO |
$181.67
|
| Rate for Payer: Humana Medicaid |
$159.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$185.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.94
|
| Rate for Payer: Molina Healthcare Passport |
$159.75
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$139.11
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$107.01
|
|
|
SIGMOIDOSCOPY & DECOMPRESS(P
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 45337
|
| Hospital Charge Code |
761P1886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.01 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Ambetter Exchange |
$107.01
|
| Rate for Payer: Anthem Medicaid |
$159.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$107.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.41
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$195.53
|
| Rate for Payer: Healthspan PPO |
$181.67
|
| Rate for Payer: Humana Medicaid |
$159.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$185.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.94
|
| Rate for Payer: Molina Healthcare Passport |
$159.75
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$139.11
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$107.01
|
|
|
SIGMOIDOSCOPY - FLEXIBLE; DIA
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 45330
|
| Hospital Charge Code |
76101882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$183.79 |
| Rate for Payer: Aetna Commercial |
$93.23
|
| Rate for Payer: Ambetter Exchange |
$53.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$52.42
|
| Rate for Payer: Anthem Medicaid |
$64.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.98
|
| 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 |
$64.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.36
|
| Rate for Payer: Molina Healthcare Passport |
$64.08
|
| Rate for Payer: Multiplan PHCS |
$103.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.32
|
| Rate for Payer: UHCCP Medicaid |
$55.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.32
|
|
|
SIGMOIDOSCOPY - FLEXIBLE; DIA
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 45330
|
| Hospital Charge Code |
76101882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.49 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$133.21
|
| Rate for Payer: Anthem Medicaid |
$59.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| 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 |
$842.40
|
| 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 |
$1,010.88
|
| 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 |
$138.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.37
|
| Rate for Payer: PHCS Commercial |
$166.08
|
| Rate for Payer: United Healthcare All Payer |
$152.24
|
|
|
SIGMOIDOSCOPY - FLEXIBLE; DIA
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 45330
|
| Hospital Charge Code |
76101882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.90 |
| 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 |
$138.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.37
|
| Rate for Payer: PHCS Commercial |
$166.08
|
| Rate for Payer: United Healthcare All Payer |
$152.24
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,179.36
|
|
|
Service Code
|
CPT 45330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
|
|
SIGMOIDOSCOPY - FLEXIBLE; DI(P
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 45330
|
| Hospital Charge Code |
761P1882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$183.79 |
| Rate for Payer: Aetna Commercial |
$93.23
|
| Rate for Payer: Ambetter Exchange |
$53.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$52.42
|
| Rate for Payer: Anthem Medicaid |
$64.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.98
|
| 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 |
$64.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.36
|
| Rate for Payer: Molina Healthcare Passport |
$64.08
|
| Rate for Payer: Multiplan PHCS |
$103.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.32
|
| Rate for Payer: UHCCP Medicaid |
$55.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.32
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)
|
Facility
|
OP
|
$1,525.23
|
|
|
Service Code
|
CPT 45350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$1,179.36
|
|
|
Service Code
|
CPT 45331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$1,525.23
|
|
|
Service Code
|
CPT 45334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$1,179.36
|
|
|
Service Code
|
CPT 45335
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$1,525.23
|
|
|
Service Code
|
CPT 45338
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC BALLOON DILATION
|
Facility
|
OP
|
$1,525.23
|
|
|
Service Code
|
CPT 45340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
|
|
SIGMOIDOSCOPY FOR BLEEDING
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 45334
|
| Hospital Charge Code |
76101884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| 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 |
$1,089.45
|
| 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 |
$1,307.34
|
| 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 |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
SIGMOIDOSCOPY FOR BLEEDING
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 45334
|
| Hospital Charge Code |
76101884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| 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 |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| 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 |
$109.55 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$249.98
|
| Rate for Payer: Ambetter Exchange |
$109.55
|
| 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 Individual/Medicaid |
$109.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$109.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.55
|
| 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 |
$142.41
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$109.55
|
|
|
SIGMOIDOSCOPY FOR BLEEDING(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 45334
|
| Hospital Charge Code |
761P1884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.55 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$249.98
|
| Rate for Payer: Ambetter Exchange |
$109.55
|
| 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 Individual/Medicaid |
$109.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$109.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.55
|
| 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 |
$142.41
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$109.55
|
|
|
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 |
$210.00 |
| Rate for Payer: Aetna Commercial |
$112.94
|
| Rate for Payer: Ambetter Exchange |
$67.86
|
| 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 Individual/Medicaid |
$67.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$67.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$81.43
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$67.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.86
|
| 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 |
$88.22
|
| Rate for Payer: UHCCP Medicaid |
$66.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$67.86
|
|
|
SIGMOIDOSCOPY W BIOPSY
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 45331
|
| Hospital Charge Code |
76101883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| 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 |
$842.40
|
| 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 |
$1,010.88
|
| 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 |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
SIGMOIDOSCOPY W BIOPSY
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 45331
|
| Hospital Charge Code |
76101883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.00 |
| 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 |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| 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 |
$210.00 |
| Rate for Payer: Aetna Commercial |
$112.94
|
| Rate for Payer: Ambetter Exchange |
$67.86
|
| 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 Individual/Medicaid |
$67.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$67.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$81.43
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$67.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.86
|
| 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 |
$88.22
|
| Rate for Payer: UHCCP Medicaid |
$66.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$67.86
|
|
|
SIGMOIDOSCOPY W/PLCMT STENT
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 45347
|
| Hospital Charge Code |
76101889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.00 |
| 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 |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
