|
COLONOSCOPY W/SNARE(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 44394
|
| Hospital Charge Code |
761P1851
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.66 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$392.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.66
|
| Rate for Payer: Anthem Medicaid |
$285.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$356.33
|
| Rate for Payer: Healthspan PPO |
$609.01
|
| Rate for Payer: Humana Medicaid |
$285.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$335.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$291.11
|
| Rate for Payer: Molina Healthcare Passport |
$285.40
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$231.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$288.25
|
|
|
COLONOSCOPY W/STENT PLCMT
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 45389
|
| Hospital Charge Code |
76101900
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Anthem Medicaid |
$243.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$547.25
|
| Rate for Payer: Humana Medicaid |
$243.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$248.27
|
| Rate for Payer: Molina Healthcare Passport |
$243.40
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.83
|
|
|
COLONOSCOPY W/STENT PLCMT
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 45389
|
| Hospital Charge Code |
76101900
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
COLONOSCOPY W/STENT PLCMT
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 45389
|
| Hospital Charge Code |
76101900
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$6,899.82 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,928.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$4,928.44
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,914.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
COLONOSCOPY W/STENT PLCMT(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 45389
|
| Hospital Charge Code |
761P1900
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Anthem Medicaid |
$243.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$547.25
|
| Rate for Payer: Humana Medicaid |
$243.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$248.27
|
| Rate for Payer: Molina Healthcare Passport |
$243.40
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.83
|
|
|
COLONSCPY STMA WWO COL SPEC PX
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 44388
|
| Hospital Charge Code |
76101849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$253.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.25
|
| Rate for Payer: Anthem Medicaid |
$191.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$231.43
|
| Rate for Payer: Healthspan PPO |
$412.88
|
| Rate for Payer: Humana Medicaid |
$191.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$216.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.56
|
| Rate for Payer: Molina Healthcare Passport |
$191.73
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$83.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.65
|
|
|
COLONSCPY STMA WWO COL SPEC PX
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 44388
|
| Hospital Charge Code |
76101849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
COLONSCPY STMA WWO COL SPEC PX
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 44388
|
| Hospital Charge Code |
76101849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$1,106.49 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| 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 |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
COLONSCPY STMA WWO COL SPEC PX
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 44388
|
| Hospital Charge Code |
761P1849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$253.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.25
|
| Rate for Payer: Anthem Medicaid |
$191.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$231.43
|
| Rate for Payer: Healthspan PPO |
$412.88
|
| Rate for Payer: Humana Medicaid |
$191.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$216.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.56
|
| Rate for Payer: Molina Healthcare Passport |
$191.73
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$83.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.65
|
|
|
COLOR DOPPLER SMA AND CELIAC
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
92100014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Aetna Commercial |
$329.00
|
| Rate for Payer: Anthem Medicaid |
$132.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$862.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$280.84
|
| Rate for Payer: Healthspan PPO |
$351.44
|
| Rate for Payer: Humana Medicaid |
$132.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$134.84
|
| Rate for Payer: Molina Healthcare Passport |
$132.20
|
| Rate for Payer: Multiplan PHCS |
$517.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$603.40
|
| Rate for Payer: UHCCP Medicaid |
$301.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$133.52
|
|
|
COLOR DOPPLER SMA AND CELIAC
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
92100014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$827.52 |
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
COLOR DOPPLER SMA AND CELIAC
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
92100014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$827.52 |
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem Medicaid |
$296.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Humana KY Medicaid |
$296.44
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$299.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
COLOR DOPPLER SMA AND CELIAC(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
921P0014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$351.44 |
| Rate for Payer: Aetna Commercial |
$329.00
|
| Rate for Payer: Anthem Medicaid |
$132.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$280.84
|
| Rate for Payer: Healthspan PPO |
$351.44
|
| Rate for Payer: Humana Medicaid |
$132.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$134.84
|
| Rate for Payer: Molina Healthcare Passport |
$132.20
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$133.52
|
|
|
COLOR DOPPLER SMA AND CELIAC(T
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
921T0014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$635.52 |
| Rate for Payer: Aetna Commercial |
$509.74
|
| Rate for Payer: Anthem Medicaid |
$227.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$516.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$549.46
|
| Rate for Payer: First Health Commercial |
$628.90
|
| Rate for Payer: Humana Commercial |
$562.70
|
| Rate for Payer: Humana KY Medicaid |
$227.66
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$229.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$488.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$232.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$582.56
|
| Rate for Payer: Ohio Health Group HMO |
$496.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.22
|
| Rate for Payer: PHCS Commercial |
$635.52
|
| Rate for Payer: United Healthcare All Payer |
$582.56
|
|
|
COLOR DOPPLER SMA AND CELIAC(T
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
921T0014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$635.52 |
| Rate for Payer: Aetna Commercial |
$509.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$516.36
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$549.46
|
| Rate for Payer: First Health Commercial |
$628.90
|
| Rate for Payer: Humana Commercial |
$562.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$488.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$582.56
|
| Rate for Payer: Ohio Health Group HMO |
$496.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.22
|
| Rate for Payer: PHCS Commercial |
$635.52
|
| Rate for Payer: United Healthcare All Payer |
$582.56
|
|
|
COLOR DOPP LIVER PORT VEIN
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$121.08 |
| Max. Negotiated Rate |
$1,142.00 |
| Rate for Payer: Aetna Commercial |
$379.47
|
| Rate for Payer: Anthem Medicaid |
$197.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,142.00
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cigna Commercial |
$483.81
|
| Rate for Payer: Healthspan PPO |
$405.36
|
| Rate for Payer: Humana Medicaid |
$197.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.56
|
| Rate for Payer: Molina Healthcare Passport |
$197.61
|
| Rate for Payer: Multiplan PHCS |
$685.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$799.40
|
| Rate for Payer: UHCCP Medicaid |
$399.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.59
|
|
|
COLOR DOPP LIVER PORT VEIN
|
Facility
|
IP
|
$1,142.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$1,096.32 |
| Rate for Payer: Aetna Commercial |
$879.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$890.76
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cigna Commercial |
$947.86
|
| Rate for Payer: First Health Commercial |
$1,084.90
|
| Rate for Payer: Humana Commercial |
$970.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$842.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,004.96
|
| Rate for Payer: Ohio Health Group HMO |
$856.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.02
|
| Rate for Payer: PHCS Commercial |
$1,096.32
|
| Rate for Payer: United Healthcare All Payer |
$1,004.96
|
|
|
COLOR DOPP LIVER PORT VEIN
|
Facility
|
OP
|
$1,142.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$1,096.32 |
| Rate for Payer: Aetna Commercial |
$879.34
|
| Rate for Payer: Anthem Medicaid |
$392.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$890.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cigna Commercial |
$947.86
|
| Rate for Payer: First Health Commercial |
$1,084.90
|
| Rate for Payer: Humana Commercial |
$970.70
|
| Rate for Payer: Humana KY Medicaid |
$392.73
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$396.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$842.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$400.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,004.96
|
| Rate for Payer: Ohio Health Group HMO |
$856.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.02
|
| Rate for Payer: PHCS Commercial |
$1,096.32
|
| Rate for Payer: United Healthcare All Payer |
$1,004.96
|
|
|
COLOR DOPP LIVER PORT VEIN(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
921P0013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$483.81 |
| Rate for Payer: Aetna Commercial |
$379.47
|
| Rate for Payer: Anthem Medicaid |
$197.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$483.81
|
| Rate for Payer: Healthspan PPO |
$405.36
|
| Rate for Payer: Humana Medicaid |
$197.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.56
|
| Rate for Payer: Molina Healthcare Passport |
$197.61
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.59
|
|
|
COLOR DOPP LIVER PORT VEIN(T
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
921T0013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.86 |
| Max. Negotiated Rate |
$885.12 |
| Rate for Payer: Aetna Commercial |
$709.94
|
| Rate for Payer: Anthem Medicaid |
$317.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$719.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$461.00
|
| Rate for Payer: Cash Price |
$461.00
|
| Rate for Payer: Cigna Commercial |
$765.26
|
| Rate for Payer: First Health Commercial |
$875.90
|
| Rate for Payer: Humana Commercial |
$783.70
|
| Rate for Payer: Humana KY Medicaid |
$317.08
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$320.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$756.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$680.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$323.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$811.36
|
| Rate for Payer: Ohio Health Group HMO |
$691.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.82
|
| Rate for Payer: PHCS Commercial |
$885.12
|
| Rate for Payer: United Healthcare All Payer |
$811.36
|
|
|
COLOR DOPP LIVER PORT VEIN(T
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
921T0013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.86 |
| Max. Negotiated Rate |
$885.12 |
| Rate for Payer: Aetna Commercial |
$709.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$719.16
|
| Rate for Payer: Cash Price |
$461.00
|
| Rate for Payer: Cigna Commercial |
$765.26
|
| Rate for Payer: First Health Commercial |
$875.90
|
| Rate for Payer: Humana Commercial |
$783.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$756.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$680.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$811.36
|
| Rate for Payer: Ohio Health Group HMO |
$691.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.82
|
| Rate for Payer: PHCS Commercial |
$885.12
|
| Rate for Payer: United Healthcare All Payer |
$811.36
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK
|
Facility
|
OP
|
$1,106.49
|
|
|
Service Code
|
CPT G0105
|
|
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
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK
|
Facility
|
OP
|
$1,106.49
|
|
|
Service Code
|
CPT G0121
|
|
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
|
|
|
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$1,106.49
|
|
|
Service Code
|
CPT G0104
|
|
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
|
|
|
COLOSTOMY OR SKIN LEVEL CECOST
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 44320
|
| Hospital Charge Code |
76101838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.03
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
