|
COLISTIMETHATE SOD 150MG/2ML
|
Facility
|
IP
|
$183.99
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
25001967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.63 |
| Rate for Payer: Aetna Commercial |
$141.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.51
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.71
|
| Rate for Payer: First Health Commercial |
$174.79
|
| Rate for Payer: Humana Commercial |
$156.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.91
|
| Rate for Payer: Ohio Health Group HMO |
$137.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.63
|
| Rate for Payer: United Healthcare All Payer |
$161.91
|
|
|
COLLECT BLD VASCULAR ACCESS
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
30000003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$58.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$58.81
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$59.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
COLLECT BLD VASCULAR ACCESS
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
30000003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
COLLECT CAPILLARY BLOOD SPEC
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Anthem Medicaid |
$3.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.00
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$4.96
|
| Rate for Payer: Healthspan PPO |
$3.84
|
| Rate for Payer: Humana Medicaid |
$3.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3.34
|
| Rate for Payer: Molina Healthcare Passport |
$3.27
|
| Rate for Payer: Multiplan PHCS |
$7.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.10
|
| Rate for Payer: UHCCP Medicaid |
$4.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.30
|
|
|
COLLECT CAPILLARY BLOOD SPEC
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$4.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.44
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Humana KY Medicaid |
$4.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.03
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
COLLECT CAPILLARY BLOOD SPEC
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.44
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.03
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
COLONOS CECUM POLYPECT
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
76101896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.07 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$412.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$231.86
|
| Rate for Payer: Anthem Medicaid |
$219.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$377.11
|
| Rate for Payer: Healthspan PPO |
$567.09
|
| Rate for Payer: Humana Medicaid |
$219.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$354.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$223.45
|
| Rate for Payer: Molina Healthcare Passport |
$219.07
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$243.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$221.26
|
|
|
COLONOS CECUM POLYPECT
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
76101896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
COLONOS CECUM POLYPECT
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
76101896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
COLONOS CECUM POLYPECT(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
761P1896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.07 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$412.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$231.86
|
| Rate for Payer: Anthem Medicaid |
$219.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$377.11
|
| Rate for Payer: Healthspan PPO |
$567.09
|
| Rate for Payer: Humana Medicaid |
$219.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$354.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$223.45
|
| Rate for Payer: Molina Healthcare Passport |
$219.07
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$243.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$221.26
|
|
|
COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,106.49
|
|
|
Service Code
|
CPT 45378
|
|
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
|
|
|
COLONOSCOPY - FLEXIBLE - PRO
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 45378
|
| Hospital Charge Code |
76101891
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.44 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$329.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.44
|
| Rate for Payer: Anthem Medicaid |
$176.59
|
| 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 |
$299.57
|
| Rate for Payer: Healthspan PPO |
$479.30
|
| Rate for Payer: Humana Medicaid |
$176.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$283.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.12
|
| Rate for Payer: Molina Healthcare Passport |
$176.59
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$98.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.36
|
|
|
COLONOSCOPY - FLEXIBLE - PRO
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 45378
|
| Hospital Charge Code |
76101891
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$1,106.49 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| 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 |
$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 |
$790.35
|
| 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 |
$948.42
|
| 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
|
|
|
COLONOSCOPY - FLEXIBLE - PRO
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 45378
|
| Hospital Charge Code |
76101891
|
|
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
|
|
|
COLONOSCOPY - FLEXIBLE - PRO(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 45378
|
| Hospital Charge Code |
761P1891
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.44 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$329.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.44
|
| Rate for Payer: Anthem Medicaid |
$176.59
|
| 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 |
$299.57
|
| Rate for Payer: Healthspan PPO |
$479.30
|
| Rate for Payer: Humana Medicaid |
$176.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$283.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.12
|
| Rate for Payer: Molina Healthcare Passport |
$176.59
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$98.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.36
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)
|
Facility
|
OP
|
$1,428.66
|
|
|
Service Code
|
CPT 45398
|
|
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
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$1,428.66
|
|
|
Service Code
|
CPT 45380
|
|
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
|
|
|
COLONOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$1,428.66
|
|
|
Service Code
|
CPT 45382
|
|
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
|
|
|
COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$1,428.66
|
|
|
Service Code
|
CPT 45381
|
|
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
|
|
|
COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$3,399.27
|
|
|
Service Code
|
CPT 45390
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,428.05 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
|
|
COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$1,428.66
|
|
|
Service Code
|
CPT 45384
|
|
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
|
|
|
COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$1,428.66
|
|
|
Service Code
|
CPT 45385
|
|
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
|
|
|
COLONOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC BALLOON DILATION
|
Facility
|
OP
|
$1,428.66
|
|
|
Service Code
|
CPT 45386
|
|
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
|
|
|
COLONOSCOPY SUBMUCOUS NJX
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 45381
|
| Hospital Charge Code |
76101894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.77 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$374.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$202.79
|
| Rate for Payer: Anthem Medicaid |
$191.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$338.28
|
| Rate for Payer: Healthspan PPO |
$558.27
|
| Rate for Payer: Humana Medicaid |
$191.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$322.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.61
|
| Rate for Payer: Molina Healthcare Passport |
$191.77
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$212.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.69
|
|
|
COLONOSCOPY SUBMUCOUS NJX
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 45381
|
| Hospital Charge Code |
76101894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
