|
COLONOSCOPY W/BALLOON DILAT(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 45386
|
| Hospital Charge Code |
761P1898
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.18 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$406.13
|
| Rate for Payer: Ambetter Exchange |
$198.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$213.87
|
| Rate for Payer: Anthem Medicaid |
$584.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$198.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$198.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$237.82
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$368.97
|
| Rate for Payer: Healthspan PPO |
$792.50
|
| Rate for Payer: Humana Medicaid |
$584.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$348.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$198.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$596.53
|
| Rate for Payer: Molina Healthcare Passport |
$584.83
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.63
|
| Rate for Payer: UHCCP Medicaid |
$224.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$590.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$198.18
|
|
|
COLONOSCOPY W/BAND LIGATION
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 45398
|
| Hospital Charge Code |
76101903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
COLONOSCOPY W/BAND LIGATION
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 45398
|
| Hospital Charge Code |
76101903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| 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 |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
COLONOSCOPY W/BAND LIGATION
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 45398
|
| Hospital Charge Code |
76101903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.75 |
| Max. Negotiated Rate |
$564.55 |
| Rate for Payer: Ambetter Exchange |
$219.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$192.75
|
| Rate for Payer: Anthem Medicaid |
$553.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$219.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$219.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$263.96
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Humana Medicaid |
$553.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$342.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$219.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$219.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.55
|
| Rate for Payer: Molina Healthcare Passport |
$553.48
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$285.96
|
| Rate for Payer: UHCCP Medicaid |
$202.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$559.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$219.97
|
|
|
COLONOSCOPY W/BAND LIGATION(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 45398
|
| Hospital Charge Code |
761P1903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.75 |
| Max. Negotiated Rate |
$564.55 |
| Rate for Payer: Ambetter Exchange |
$219.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$192.75
|
| Rate for Payer: Anthem Medicaid |
$553.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$219.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$219.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$263.96
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Humana Medicaid |
$553.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$342.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$219.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$219.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.55
|
| Rate for Payer: Molina Healthcare Passport |
$553.48
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$285.96
|
| Rate for Payer: UHCCP Medicaid |
$202.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$559.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$219.97
|
|
|
COLONOSCOPY W/CONTROL BLEED
|
Professional
|
Both
|
$1,160.00
|
|
|
Service Code
|
HCPCS 45382
|
| Hospital Charge Code |
76101895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.05 |
| Max. Negotiated Rate |
$756.12 |
| Rate for Payer: Aetna Commercial |
$505.89
|
| Rate for Payer: Ambetter Exchange |
$241.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$262.66
|
| Rate for Payer: Anthem Medicaid |
$639.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$241.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$241.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.26
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$455.62
|
| Rate for Payer: Healthspan PPO |
$756.12
|
| Rate for Payer: Humana Medicaid |
$639.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$433.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$241.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$652.33
|
| Rate for Payer: Molina Healthcare Passport |
$639.54
|
| Rate for Payer: Multiplan PHCS |
$696.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$313.37
|
| Rate for Payer: UHCCP Medicaid |
$275.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$645.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$241.05
|
|
|
COLONOSCOPY W/CONTROL BLEED
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
HCPCS 45382
|
| Hospital Charge Code |
76101895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.92 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$893.20
|
| Rate for Payer: Anthem Medicaid |
$398.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.80
|
| 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 |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$962.80
|
| Rate for Payer: First Health Commercial |
$1,102.00
|
| Rate for Payer: Humana Commercial |
$986.00
|
| Rate for Payer: Humana KY Medicaid |
$398.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$402.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$951.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$856.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.80
|
| Rate for Payer: Ohio Health Group HMO |
$870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$928.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$800.40
|
| Rate for Payer: PHCS Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Payer |
$1,020.80
|
|
|
COLONOSCOPY W/CONTROL BLEED
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
HCPCS 45382
|
| Hospital Charge Code |
76101895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$1,113.60 |
| Rate for Payer: Aetna Commercial |
$893.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.80
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$962.80
|
| Rate for Payer: First Health Commercial |
$1,102.00
|
| Rate for Payer: Humana Commercial |
$986.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$951.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$856.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.80
|
| Rate for Payer: Ohio Health Group HMO |
$870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$928.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$800.40
|
| Rate for Payer: PHCS Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Payer |
$1,020.80
|
|
|
COLONOSCOPY W/CONTROL BLEED(P
|
Professional
|
Both
|
$1,160.00
|
|
|
Service Code
|
HCPCS 45382
|
| Hospital Charge Code |
761P1895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.05 |
| Max. Negotiated Rate |
$756.12 |
| Rate for Payer: Aetna Commercial |
$505.89
|
| Rate for Payer: Ambetter Exchange |
$241.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$262.66
|
| Rate for Payer: Anthem Medicaid |
$639.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$241.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$241.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.26
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$455.62
|
| Rate for Payer: Healthspan PPO |
$756.12
|
| Rate for Payer: Humana Medicaid |
$639.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$433.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$241.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$652.33
|
| Rate for Payer: Molina Healthcare Passport |
$639.54
|
| Rate for Payer: Multiplan PHCS |
$696.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$313.37
|
| Rate for Payer: UHCCP Medicaid |
$275.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$645.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$241.05
|
|
|
COLONOSCOPY W/DECOMPRESSION
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
HCPCS 45393
|
| Hospital Charge Code |
76101902
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.00 |
| Max. Negotiated Rate |
$854.40 |
| Rate for Payer: Aetna Commercial |
$685.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.20
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$738.70
|
| Rate for Payer: First Health Commercial |
$845.50
|
| Rate for Payer: Humana Commercial |
$756.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$729.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$656.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$267.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$783.20
|
| Rate for Payer: Ohio Health Group HMO |
$667.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.10
|
| Rate for Payer: PHCS Commercial |
$854.40
|
| Rate for Payer: United Healthcare All Payer |
$783.20
|
|
|
COLONOSCOPY W/DECOMPRESSION
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 45393
|
| Hospital Charge Code |
76101902
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.95 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Ambetter Exchange |
$234.49
|
| Rate for Payer: Anthem Medicaid |
$212.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$234.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$234.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$281.39
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Humana Medicaid |
$212.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$368.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$234.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.21
|
| Rate for Payer: Molina Healthcare Passport |
$212.95
|
| Rate for Payer: Multiplan PHCS |
$534.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$304.84
|
| Rate for Payer: UHCCP Medicaid |
$311.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$234.49
|
|
|
COLONOSCOPY W/DECOMPRESSION
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
HCPCS 45393
|
| Hospital Charge Code |
76101902
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.07 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$685.30
|
| Rate for Payer: Anthem Medicaid |
$306.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.20
|
| 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 |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$738.70
|
| Rate for Payer: First Health Commercial |
$845.50
|
| Rate for Payer: Humana Commercial |
$756.50
|
| Rate for Payer: Humana KY Medicaid |
$306.07
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$309.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$729.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$656.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$312.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$783.20
|
| Rate for Payer: Ohio Health Group HMO |
$667.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.10
|
| Rate for Payer: PHCS Commercial |
$854.40
|
| Rate for Payer: United Healthcare All Payer |
$783.20
|
|
|
COLONOSCOPY W/DECOMPRESSION(P
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 45393
|
| Hospital Charge Code |
761P1902
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.95 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Ambetter Exchange |
$234.49
|
| Rate for Payer: Anthem Medicaid |
$212.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$234.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$234.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$281.39
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Humana Medicaid |
$212.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$368.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$234.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.21
|
| Rate for Payer: Molina Healthcare Passport |
$212.95
|
| Rate for Payer: Multiplan PHCS |
$534.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$304.84
|
| Rate for Payer: UHCCP Medicaid |
$311.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$234.49
|
|
|
COLONOSCOPY W/DILATION
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44405
|
| Hospital Charge Code |
76101852
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.85 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Ambetter Exchange |
$170.85
|
| Rate for Payer: Anthem Medicaid |
$461.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$170.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$170.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$205.02
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Humana Medicaid |
$461.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$170.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.63
|
| Rate for Payer: Molina Healthcare Passport |
$461.40
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$222.10
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$466.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$170.85
|
|
|
COLONOSCOPY W/DILATION
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44405
|
| Hospital Charge Code |
76101852
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
COLONOSCOPY W/DILATION
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44405
|
| Hospital Charge Code |
76101852
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.88 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| 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 |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Humana KY Medicaid |
$429.88
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$434.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
COLONOSCOPY W/DILATION(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 44405
|
| Hospital Charge Code |
761P1852
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.85 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Ambetter Exchange |
$170.85
|
| Rate for Payer: Anthem Medicaid |
$461.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$170.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$170.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$205.02
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Humana Medicaid |
$461.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$170.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.63
|
| Rate for Payer: Molina Healthcare Passport |
$461.40
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$222.10
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$466.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$170.85
|
|
|
COLONOSCOPY W/FB REMOVAL
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 45379
|
| Hospital Charge Code |
76101892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.28 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem Medicaid |
$421.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| 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 |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Humana KY Medicaid |
$421.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$425.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$429.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$845.25
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
COLONOSCOPY W/FB REMOVAL
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 45379
|
| Hospital Charge Code |
76101892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$845.25
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
COLONOSCOPY W/FB REMOVAL
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 45379
|
| Hospital Charge Code |
76101892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.12 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$413.56
|
| Rate for Payer: Ambetter Exchange |
$222.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$232.50
|
| Rate for Payer: Anthem Medicaid |
$417.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$222.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$222.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$266.54
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$376.53
|
| Rate for Payer: Healthspan PPO |
$608.74
|
| Rate for Payer: Humana Medicaid |
$417.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$355.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$222.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$425.45
|
| Rate for Payer: Molina Healthcare Passport |
$417.11
|
| Rate for Payer: Multiplan PHCS |
$735.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$288.76
|
| Rate for Payer: UHCCP Medicaid |
$244.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$421.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$222.12
|
|
|
COLONOSCOPY W/FB REMOVAL(P
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 45379
|
| Hospital Charge Code |
761P1892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.12 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$413.56
|
| Rate for Payer: Ambetter Exchange |
$222.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$232.50
|
| Rate for Payer: Anthem Medicaid |
$417.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$222.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$222.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$266.54
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$376.53
|
| Rate for Payer: Healthspan PPO |
$608.74
|
| Rate for Payer: Humana Medicaid |
$417.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$355.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$222.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$425.45
|
| Rate for Payer: Molina Healthcare Passport |
$417.11
|
| Rate for Payer: Multiplan PHCS |
$735.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$288.76
|
| Rate for Payer: UHCCP Medicaid |
$244.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$421.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$222.12
|
|
|
COLONOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 44389
|
| Hospital Charge Code |
76101850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,036.80 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$842.40
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$896.40
|
| Rate for Payer: First Health Commercial |
$1,026.00
|
| Rate for Payer: Humana Commercial |
$918.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$885.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$797.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$950.40
|
| Rate for Payer: Ohio Health Group HMO |
$810.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$939.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$745.20
|
| Rate for Payer: PHCS Commercial |
$1,036.80
|
| Rate for Payer: United Healthcare All Payer |
$950.40
|
|
|
COLONOSCOPY WITH BIOPSY
|
Professional
|
Both
|
$1,080.00
|
|
|
Service Code
|
HCPCS 44389
|
| Hospital Charge Code |
76101850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.44 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$281.81
|
| Rate for Payer: Ambetter Exchange |
$160.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$158.44
|
| Rate for Payer: Anthem Medicaid |
$210.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$160.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$160.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$192.77
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$256.24
|
| Rate for Payer: Healthspan PPO |
$478.22
|
| Rate for Payer: Humana Medicaid |
$210.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$241.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$160.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.27
|
| Rate for Payer: Molina Healthcare Passport |
$210.07
|
| Rate for Payer: Multiplan PHCS |
$648.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$208.83
|
| Rate for Payer: UHCCP Medicaid |
$166.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$212.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$160.64
|
|
|
COLONOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 44389
|
| Hospital Charge Code |
76101850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.41 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Anthem Medicaid |
$371.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$842.40
|
| 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 |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$896.40
|
| Rate for Payer: First Health Commercial |
$1,026.00
|
| Rate for Payer: Humana Commercial |
$918.00
|
| Rate for Payer: Humana KY Medicaid |
$371.41
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$375.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$885.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$797.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$950.40
|
| Rate for Payer: Ohio Health Group HMO |
$810.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$939.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$745.20
|
| Rate for Payer: PHCS Commercial |
$1,036.80
|
| Rate for Payer: United Healthcare All Payer |
$950.40
|
|
|
COLONOSCOPY WITH BIOPSY(P
|
Professional
|
Both
|
$1,080.00
|
|
|
Service Code
|
HCPCS 44389
|
| Hospital Charge Code |
761P1850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.44 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$281.81
|
| Rate for Payer: Ambetter Exchange |
$160.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$158.44
|
| Rate for Payer: Anthem Medicaid |
$210.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$160.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$160.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$192.77
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$256.24
|
| Rate for Payer: Healthspan PPO |
$478.22
|
| Rate for Payer: Humana Medicaid |
$210.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$241.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$160.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.27
|
| Rate for Payer: Molina Healthcare Passport |
$210.07
|
| Rate for Payer: Multiplan PHCS |
$648.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$208.83
|
| Rate for Payer: UHCCP Medicaid |
$166.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$212.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$160.64
|
|
