|
SL-PLUS SDP W/ANTEVRTD HOLE 7
|
Facility
|
OP
|
$26,267.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,880.16 |
| Max. Negotiated Rate |
$25,216.50 |
| Rate for Payer: Aetna Commercial |
$20,225.74
|
| Rate for Payer: Anthem Medicaid |
$9,033.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,488.41
|
| Rate for Payer: Cash Price |
$13,133.59
|
| Rate for Payer: Cigna Commercial |
$21,801.77
|
| Rate for Payer: First Health Commercial |
$24,953.83
|
| Rate for Payer: Humana Commercial |
$22,327.11
|
| Rate for Payer: Humana KY Medicaid |
$9,033.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,125.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,539.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,385.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,880.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,214.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,115.13
|
| Rate for Payer: Ohio Health Group HMO |
$19,700.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,013.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,852.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,124.36
|
| Rate for Payer: PHCS Commercial |
$25,216.50
|
| Rate for Payer: United Healthcare All Payer |
$23,115.13
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 44369
|
| Hospital Charge Code |
76102623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 44382
|
| Hospital Charge Code |
76101848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
SMALL BOWEL ENDOSCOPY
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 44360
|
| Hospital Charge Code |
76101843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.55 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$240.12
|
| Rate for Payer: Ambetter Exchange |
$133.55
|
| Rate for Payer: Anthem Medicaid |
$193.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.26
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$215.05
|
| Rate for Payer: Healthspan PPO |
$202.50
|
| Rate for Payer: Humana Medicaid |
$193.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$205.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.65
|
| Rate for Payer: Molina Healthcare Passport |
$193.77
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.55
|
|
|
SMALL BOWEL ENDOSCOPY
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 44369
|
| Hospital Charge Code |
76102623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$406.96 |
| Rate for Payer: Aetna Commercial |
$406.96
|
| Rate for Payer: Ambetter Exchange |
$228.35
|
| Rate for Payer: Anthem Medicaid |
$336.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$228.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$228.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$274.02
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$363.73
|
| Rate for Payer: Healthspan PPO |
$343.20
|
| Rate for Payer: Humana Medicaid |
$336.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$347.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$228.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$343.12
|
| Rate for Payer: Molina Healthcare Passport |
$336.39
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$296.86
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$228.35
|
|
|
SMALL BOWEL ENDOSCOPY
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 44382
|
| Hospital Charge Code |
76101848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$126.29
|
| Rate for Payer: Ambetter Exchange |
$69.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.22
|
| Rate for Payer: Anthem Medicaid |
$122.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$69.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.90
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$111.05
|
| Rate for Payer: Healthspan PPO |
$106.50
|
| Rate for Payer: Humana Medicaid |
$122.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$69.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.41
|
| Rate for Payer: Molina Healthcare Passport |
$122.95
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$89.80
|
| Rate for Payer: UHCCP Medicaid |
$59.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$124.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$69.08
|
|
|
SMALL BOWEL ENDOSCOPY
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 44369
|
| Hospital Charge Code |
761P2623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$406.96 |
| Rate for Payer: Aetna Commercial |
$406.96
|
| Rate for Payer: Ambetter Exchange |
$228.35
|
| Rate for Payer: Anthem Medicaid |
$336.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$228.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$228.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$274.02
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$363.73
|
| Rate for Payer: Healthspan PPO |
$343.20
|
| Rate for Payer: Humana Medicaid |
$336.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$347.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$228.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$343.12
|
| Rate for Payer: Molina Healthcare Passport |
$336.39
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$296.86
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$228.35
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 44360
|
| Hospital Charge Code |
76101843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.50 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.75
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 44382
|
| Hospital Charge Code |
76101848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.53 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Humana KY Medicaid |
$223.53
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 44369
|
| Hospital Charge Code |
76102623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 44360
|
| Hospital Charge Code |
76101843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.52 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem Medicaid |
$266.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Humana KY Medicaid |
$266.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$269.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.75
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
SMALL BOWEL ENDOSCOPY/BIOPSY
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 44361
|
| Hospital Charge Code |
76101844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
SMALL BOWEL ENDOSCOPY/BIOPSY
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 44361
|
| Hospital Charge Code |
76101844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.77 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$264.66
|
| Rate for Payer: Ambetter Exchange |
$147.77
|
| Rate for Payer: Anthem Medicaid |
$214.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$147.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$177.32
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$237.02
|
| Rate for Payer: Healthspan PPO |
$223.20
|
| Rate for Payer: Humana Medicaid |
$214.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$226.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$147.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.36
|
| Rate for Payer: Molina Healthcare Passport |
$214.08
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.10
|
| Rate for Payer: UHCCP Medicaid |
$306.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.77
|
|
|
SMALL BOWEL ENDOSCOPY/BIOPSY
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 44361
|
| Hospital Charge Code |
76101844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.91 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem Medicaid |
$300.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Humana KY Medicaid |
$300.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$303.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
SMALL BOWEL ENDOSCOPY/BIOPSY(P
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 44361
|
| Hospital Charge Code |
761P1844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.77 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$264.66
|
| Rate for Payer: Ambetter Exchange |
$147.77
|
| Rate for Payer: Anthem Medicaid |
$214.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$147.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$177.32
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$237.02
|
| Rate for Payer: Healthspan PPO |
$223.20
|
| Rate for Payer: Humana Medicaid |
$214.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$226.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$147.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.36
|
| Rate for Payer: Molina Healthcare Passport |
$214.08
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.10
|
| Rate for Payer: UHCCP Medicaid |
$306.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.77
|
|
|
SMALL BOWEL ENDOSCOPY(P
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 44360
|
| Hospital Charge Code |
761P1843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.55 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$240.12
|
| Rate for Payer: Ambetter Exchange |
$133.55
|
| Rate for Payer: Anthem Medicaid |
$193.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.26
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$215.05
|
| Rate for Payer: Healthspan PPO |
$202.50
|
| Rate for Payer: Humana Medicaid |
$193.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$205.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.65
|
| Rate for Payer: Molina Healthcare Passport |
$193.77
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.55
|
|
|
SMALL BOWEL ENDOSCOPY(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 44382
|
| Hospital Charge Code |
761P1848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$126.29
|
| Rate for Payer: Ambetter Exchange |
$69.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.22
|
| Rate for Payer: Anthem Medicaid |
$122.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$69.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.90
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$111.05
|
| Rate for Payer: Healthspan PPO |
$106.50
|
| Rate for Payer: Humana Medicaid |
$122.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$69.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.41
|
| Rate for Payer: Molina Healthcare Passport |
$122.95
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$89.80
|
| Rate for Payer: UHCCP Medicaid |
$59.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$124.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$69.08
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,453.89
|
|
|
Service Code
|
CPT 44360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,752.78 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,453.89
|
|
|
Service Code
|
CPT 44361
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,752.78 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR)
|
Facility
|
OP
|
$2,453.89
|
|
|
Service Code
|
CPT 44366
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,752.78 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH PLACEMENT OF PERCUTANEOUS JEJUNOSTOMY TUBE
|
Facility
|
OP
|
$2,453.89
|
|
|
Service Code
|
CPT 44372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,752.78 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
|
|
SMART CONTROL ILIAC 10*60
|
Facility
|
IP
|
$4,343.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.12 |
| Max. Negotiated Rate |
$4,170.00 |
| Rate for Payer: Aetna Commercial |
$3,344.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,388.12
|
| Rate for Payer: Cash Price |
$2,171.88
|
| Rate for Payer: Cigna Commercial |
$3,605.31
|
| Rate for Payer: First Health Commercial |
$4,126.56
|
| Rate for Payer: Humana Commercial |
$3,692.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,822.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,779.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.19
|
| Rate for Payer: PHCS Commercial |
$4,170.00
|
| Rate for Payer: United Healthcare All Payer |
$3,822.50
|
|
|
SMART CONTROL ILIAC 10*60
|
Facility
|
OP
|
$4,343.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.12 |
| Max. Negotiated Rate |
$4,170.00 |
| Rate for Payer: Aetna Commercial |
$3,344.69
|
| Rate for Payer: Anthem Medicaid |
$1,493.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,388.12
|
| Rate for Payer: Cash Price |
$2,171.88
|
| Rate for Payer: Cigna Commercial |
$3,605.31
|
| Rate for Payer: First Health Commercial |
$4,126.56
|
| Rate for Payer: Humana Commercial |
$3,692.19
|
| Rate for Payer: Humana KY Medicaid |
$1,493.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,509.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,523.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,822.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,779.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.19
|
| Rate for Payer: PHCS Commercial |
$4,170.00
|
| Rate for Payer: United Healthcare All Payer |
$3,822.50
|
|
|
SMART CONTROL ILIAC 6*100
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem Medicaid |
$1,526.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Humana KY Medicaid |
$1,526.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,541.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,556.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
SMART CONTROL ILIAC 6*100
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
