|
COLOR DOPPLER SMA AND CELIAC
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
92100014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$868.80 |
| Rate for Payer: Aetna Commercial |
$696.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$705.90
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$751.15
|
| Rate for Payer: First Health Commercial |
$859.75
|
| Rate for Payer: Humana Commercial |
$769.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$667.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$796.40
|
| Rate for Payer: Ohio Health Group HMO |
$678.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$787.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.45
|
| Rate for Payer: PHCS Commercial |
$868.80
|
| Rate for Payer: United Healthcare All Payer |
$796.40
|
|
|
COLOR DOPPLER SMA AND CELIAC
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
92100014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$868.80 |
| Rate for Payer: Aetna Commercial |
$696.85
|
| Rate for Payer: Anthem Medicaid |
$311.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$705.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$751.15
|
| Rate for Payer: First Health Commercial |
$859.75
|
| Rate for Payer: Humana Commercial |
$769.25
|
| Rate for Payer: Humana KY Medicaid |
$311.23
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$314.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$667.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$317.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$796.40
|
| Rate for Payer: Ohio Health Group HMO |
$678.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$787.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.45
|
| Rate for Payer: PHCS Commercial |
$868.80
|
| Rate for Payer: United Healthcare All Payer |
$796.40
|
|
|
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: Ambetter Exchange |
$141.96
|
| Rate for Payer: Anthem Medicaid |
$132.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$141.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$141.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$170.35
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$141.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.96
|
| 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 |
$184.55
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$133.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$141.96
|
|
|
COLOR DOPPLER SMA AND CELIAC(T
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
921T0014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem Medicaid |
$242.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Humana KY Medicaid |
$242.45
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$244.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$247.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.45
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
COLOR DOPPLER SMA AND CELIAC(T
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
921T0014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.45
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
COLOR DOPP LIVER PORT VEIN
|
Facility
|
IP
|
$1,202.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$360.60 |
| Max. Negotiated Rate |
$1,153.92 |
| Rate for Payer: Aetna Commercial |
$925.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$937.56
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Cigna Commercial |
$997.66
|
| Rate for Payer: First Health Commercial |
$1,141.90
|
| Rate for Payer: Humana Commercial |
$1,021.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$985.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$887.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,057.76
|
| Rate for Payer: Ohio Health Group HMO |
$901.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,045.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$829.38
|
| Rate for Payer: PHCS Commercial |
$1,153.92
|
| Rate for Payer: United Healthcare All Payer |
$1,057.76
|
|
|
COLOR DOPP LIVER PORT VEIN
|
Facility
|
OP
|
$1,202.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,153.92 |
| Rate for Payer: Aetna Commercial |
$925.54
|
| Rate for Payer: Anthem Medicaid |
$413.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$937.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Cigna Commercial |
$997.66
|
| Rate for Payer: First Health Commercial |
$1,141.90
|
| Rate for Payer: Humana Commercial |
$1,021.70
|
| Rate for Payer: Humana KY Medicaid |
$413.37
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$417.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$985.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$887.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$421.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,057.76
|
| Rate for Payer: Ohio Health Group HMO |
$901.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,045.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$829.38
|
| Rate for Payer: PHCS Commercial |
$1,153.92
|
| Rate for Payer: United Healthcare All Payer |
$1,057.76
|
|
|
COLOR DOPP LIVER PORT VEIN
|
Professional
|
Both
|
$1,202.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$121.08 |
| Max. Negotiated Rate |
$721.20 |
| Rate for Payer: Aetna Commercial |
$379.47
|
| Rate for Payer: Ambetter Exchange |
$233.96
|
| Rate for Payer: Anthem Medicaid |
$197.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$233.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$233.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$280.75
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Cash Price |
$601.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$233.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.56
|
| Rate for Payer: Molina Healthcare Passport |
$197.61
|
| Rate for Payer: Multiplan PHCS |
$721.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$304.15
|
| Rate for Payer: UHCCP Medicaid |
$420.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$233.96
|
|
|
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: Ambetter Exchange |
$233.96
|
| Rate for Payer: Anthem Medicaid |
$197.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$233.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$233.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$280.75
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$233.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.96
|
| 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 |
$304.15
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$233.96
|
|
|
COLOR DOPP LIVER PORT VEIN(T
|
Facility
|
OP
|
$982.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
921T0013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$942.72 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Anthem Medicaid |
$337.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$815.06
|
| Rate for Payer: First Health Commercial |
$932.90
|
| Rate for Payer: Humana Commercial |
$834.70
|
| Rate for Payer: Humana KY Medicaid |
$337.71
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$341.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$805.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$724.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$864.16
|
| Rate for Payer: Ohio Health Group HMO |
$736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.58
|
| Rate for Payer: PHCS Commercial |
$942.72
|
| Rate for Payer: United Healthcare All Payer |
$864.16
|
|
|
COLOR DOPP LIVER PORT VEIN(T
|
Facility
|
IP
|
$982.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
921T0013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$294.60 |
| Max. Negotiated Rate |
$942.72 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.96
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$815.06
|
| Rate for Payer: First Health Commercial |
$932.90
|
| Rate for Payer: Humana Commercial |
$834.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$805.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$724.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$864.16
|
| Rate for Payer: Ohio Health Group HMO |
$736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.58
|
| Rate for Payer: PHCS Commercial |
$942.72
|
| Rate for Payer: United Healthcare All Payer |
$864.16
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK
|
Facility
|
OP
|
$1,179.36
|
|
|
Service Code
|
CPT G0105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK
|
Facility
|
OP
|
$1,179.36
|
|
|
Service Code
|
CPT G0121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
|
|
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$1,179.36
|
|
|
Service Code
|
CPT G0104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
|
|
COLOSTOMY OR SKIN LEVEL CECOST
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 44320
|
| Hospital Charge Code |
76101838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.90 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem Medicaid |
$554.71
|
| 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: Humana KY Medicaid |
$554.71
|
| Rate for Payer: Kentucky WC Medicaid |
$560.36
|
| 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: Molina Healthcare Medicaid |
$565.84
|
| 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 |
$1,290.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,112.97
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
COLOSTOMY OR SKIN LEVEL CECOST
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 44320
|
| Hospital Charge Code |
76101838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.55 |
| Max. Negotiated Rate |
$1,721.18 |
| Rate for Payer: Aetna Commercial |
$1,721.18
|
| Rate for Payer: Ambetter Exchange |
$1,139.35
|
| Rate for Payer: Anthem Medicaid |
$572.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,139.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,139.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,367.22
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,598.46
|
| Rate for Payer: Healthspan PPO |
$1,451.51
|
| Rate for Payer: Humana Medicaid |
$572.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,529.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,139.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,139.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$583.91
|
| Rate for Payer: Molina Healthcare Passport |
$572.46
|
| Rate for Payer: Multiplan PHCS |
$967.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,481.15
|
| Rate for Payer: UHCCP Medicaid |
$564.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$578.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,139.35
|
|
|
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 |
$483.90 |
| 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 |
$1,290.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,112.97
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
COLOSTOMY OR SKIN LEVEL CECOST
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 44320
|
| Hospital Charge Code |
761P1838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.55 |
| Max. Negotiated Rate |
$1,721.18 |
| Rate for Payer: Aetna Commercial |
$1,721.18
|
| Rate for Payer: Ambetter Exchange |
$1,139.35
|
| Rate for Payer: Anthem Medicaid |
$572.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,139.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,139.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,367.22
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,598.46
|
| Rate for Payer: Healthspan PPO |
$1,451.51
|
| Rate for Payer: Humana Medicaid |
$572.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,529.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,139.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,139.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$583.91
|
| Rate for Payer: Molina Healthcare Passport |
$572.46
|
| Rate for Payer: Multiplan PHCS |
$967.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,481.15
|
| Rate for Payer: UHCCP Medicaid |
$564.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$578.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,139.35
|
|
|
COLOSTOMY;WITH MULT BX COLON
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44322
|
| Hospital Charge Code |
76101839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.50 |
| Max. Negotiated Rate |
$1,352.07 |
| Rate for Payer: Aetna Commercial |
$1,352.07
|
| Rate for Payer: Ambetter Exchange |
$944.08
|
| Rate for Payer: Anthem Medicaid |
$591.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$944.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$944.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,132.90
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,269.87
|
| Rate for Payer: Healthspan PPO |
$1,140.22
|
| Rate for Payer: Humana Medicaid |
$591.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,238.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$944.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$603.32
|
| Rate for Payer: Molina Healthcare Passport |
$591.49
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,227.30
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$944.08
|
|
|
COLOSTOMY;WITH MULT BX COLON
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44322
|
| Hospital Charge Code |
76101839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem Medicaid |
$533.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Humana KY Medicaid |
$533.04
|
| Rate for Payer: Kentucky WC Medicaid |
$538.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
COLOSTOMY;WITH MULT BX COLON
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44322
|
| Hospital Charge Code |
76101839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
COLOSTOMY;WITH MULT BX COLON(P
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44322
|
| Hospital Charge Code |
761P1839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.50 |
| Max. Negotiated Rate |
$1,352.07 |
| Rate for Payer: Aetna Commercial |
$1,352.07
|
| Rate for Payer: Ambetter Exchange |
$944.08
|
| Rate for Payer: Anthem Medicaid |
$591.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$944.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$944.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,132.90
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,269.87
|
| Rate for Payer: Healthspan PPO |
$1,140.22
|
| Rate for Payer: Humana Medicaid |
$591.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,238.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$944.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$603.32
|
| Rate for Payer: Molina Healthcare Passport |
$591.49
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,227.30
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$944.08
|
|
|
COLOTOMY - FOR EXPLORATION -
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44025
|
| Hospital Charge Code |
76101807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.56 |
| Max. Negotiated Rate |
$1,420.93 |
| Rate for Payer: Aetna Commercial |
$1,420.93
|
| Rate for Payer: Ambetter Exchange |
$936.48
|
| Rate for Payer: Anthem Medicaid |
$571.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$936.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$936.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,123.78
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,314.44
|
| Rate for Payer: Healthspan PPO |
$1,198.30
|
| Rate for Payer: Humana Medicaid |
$571.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,259.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$936.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.99
|
| Rate for Payer: Molina Healthcare Passport |
$571.56
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,217.42
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$577.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$936.48
|
|
|
COLOTOMY - FOR EXPLORATION -
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44025
|
| Hospital Charge Code |
76101807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
COLOTOMY - FOR EXPLORATION -
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44025
|
| Hospital Charge Code |
76101807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.61
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
