|
LAP W/UNA
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58662
|
| Hospital Charge Code |
76102250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
LAP W/UNA
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58662
|
| Hospital Charge Code |
76102250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.04 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,075.88
|
| Rate for Payer: Anthem Medicaid |
$507.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,053.93
|
| Rate for Payer: Healthspan PPO |
$1,041.72
|
| Rate for Payer: Humana Medicaid |
$507.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$917.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$517.18
|
| Rate for Payer: Molina Healthcare Passport |
$507.04
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$512.11
|
|
|
LAP W/UNA
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58662
|
| Hospital Charge Code |
76102250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
LAP W/UNA(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58662
|
| Hospital Charge Code |
761P2250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.04 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,075.88
|
| Rate for Payer: Anthem Medicaid |
$507.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,053.93
|
| Rate for Payer: Healthspan PPO |
$1,041.72
|
| Rate for Payer: Humana Medicaid |
$507.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$917.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$517.18
|
| Rate for Payer: Molina Healthcare Passport |
$507.04
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$512.11
|
|
|
LAP W/UTERINE SUSPENSION
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58400
|
| Hospital Charge Code |
76102226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
LAP W/UTERINE SUSPENSION
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58400
|
| Hospital Charge Code |
76102226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.55 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$673.45
|
| Rate for Payer: Anthem Medicaid |
$345.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$648.96
|
| Rate for Payer: Healthspan PPO |
$652.07
|
| Rate for Payer: Humana Medicaid |
$345.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$352.46
|
| Rate for Payer: Molina Healthcare Passport |
$345.55
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$349.01
|
|
|
LAP W/UTERINE SUSPENSION
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58400
|
| Hospital Charge Code |
76102226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
LAP W/UTERINE SUSPENSION(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58400
|
| Hospital Charge Code |
761P2226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.55 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$673.45
|
| Rate for Payer: Anthem Medicaid |
$345.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$648.96
|
| Rate for Payer: Healthspan PPO |
$652.07
|
| Rate for Payer: Humana Medicaid |
$345.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$352.46
|
| Rate for Payer: Molina Healthcare Passport |
$345.55
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$349.01
|
|
|
LAP W/VAGINAL HYSTERECTOMY
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 58552
|
| Hospital Charge Code |
76102231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
LAP W/VAGINAL HYSTERECTOMY
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 58552
|
| Hospital Charge Code |
76102231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$12,462.13 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,901.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,462.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,017.05
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Humana Medicare Advantage |
$8,901.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,681.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
LAP W/VAGINAL HYSTERECTOMY
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 58552
|
| Hospital Charge Code |
76102231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$640.10 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$1,475.07
|
| Rate for Payer: Anthem Medicaid |
$640.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,448.17
|
| Rate for Payer: Healthspan PPO |
$1,428.25
|
| Rate for Payer: Humana Medicaid |
$640.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,275.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$652.90
|
| Rate for Payer: Molina Healthcare Passport |
$640.10
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$646.50
|
|
|
LAP W/VAGINAL HYSTERECTOMY(P
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 58552
|
| Hospital Charge Code |
761P2231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$640.10 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$1,475.07
|
| Rate for Payer: Anthem Medicaid |
$640.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,448.17
|
| Rate for Payer: Healthspan PPO |
$1,428.25
|
| Rate for Payer: Humana Medicaid |
$640.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,275.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$652.90
|
| Rate for Payer: Molina Healthcare Passport |
$640.10
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$646.50
|
|
|
LARYNGEAL FUNCTION STUDIES
|
Facility
|
IP
|
$419.75
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
76102452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$402.96 |
| Rate for Payer: Aetna Commercial |
$323.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.40
|
| Rate for Payer: Cash Price |
$209.88
|
| Rate for Payer: Cigna Commercial |
$348.39
|
| Rate for Payer: First Health Commercial |
$398.76
|
| Rate for Payer: Humana Commercial |
$356.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.38
|
| Rate for Payer: Ohio Health Group HMO |
$314.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.12
|
| Rate for Payer: PHCS Commercial |
$402.96
|
| Rate for Payer: United Healthcare All Payer |
$369.38
|
|
|
LARYNGEAL FUNCTION STUDIES
|
Facility
|
OP
|
$419.75
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
76102452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$402.96 |
| Rate for Payer: Aetna Commercial |
$323.21
|
| Rate for Payer: Anthem Medicaid |
$144.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$209.88
|
| Rate for Payer: Cash Price |
$209.88
|
| Rate for Payer: Cigna Commercial |
$348.39
|
| Rate for Payer: First Health Commercial |
$398.76
|
| Rate for Payer: Humana Commercial |
$356.79
|
| Rate for Payer: Humana KY Medicaid |
$144.35
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$145.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.38
|
| Rate for Payer: Ohio Health Group HMO |
$314.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.12
|
| Rate for Payer: PHCS Commercial |
$402.96
|
| Rate for Payer: United Healthcare All Payer |
$369.38
|
|
|
LARYNGEAL FUNCTION STUDIES
|
Professional
|
Both
|
$419.75
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
76102452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.07 |
| Max. Negotiated Rate |
$419.75 |
| Rate for Payer: Aetna Commercial |
$39.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.07
|
| Rate for Payer: Anthem Medicaid |
$30.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$419.75
|
| Rate for Payer: Cash Price |
$209.88
|
| Rate for Payer: Cash Price |
$209.88
|
| Rate for Payer: Cigna Commercial |
$76.29
|
| Rate for Payer: Healthspan PPO |
$73.98
|
| Rate for Payer: Humana Medicaid |
$30.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.23
|
| Rate for Payer: Molina Healthcare Passport |
$30.62
|
| Rate for Payer: Multiplan PHCS |
$251.85
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$293.82
|
| Rate for Payer: UHCCP Medicaid |
$21.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.93
|
|
|
LARYNGEAL FUNCTION STUDIES(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
761P2452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.07 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$39.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.07
|
| Rate for Payer: Anthem Medicaid |
$30.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$76.29
|
| Rate for Payer: Healthspan PPO |
$73.98
|
| Rate for Payer: Humana Medicaid |
$30.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.23
|
| Rate for Payer: Molina Healthcare Passport |
$30.62
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$21.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.93
|
|
|
LARYNGEAL FUNCTION STUDIES(T
|
Facility
|
IP
|
$319.75
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
761T2452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$306.96 |
| Rate for Payer: Aetna Commercial |
$246.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.40
|
| Rate for Payer: Cash Price |
$159.88
|
| Rate for Payer: Cigna Commercial |
$265.39
|
| Rate for Payer: First Health Commercial |
$303.76
|
| Rate for Payer: Humana Commercial |
$271.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$262.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.38
|
| Rate for Payer: Ohio Health Group HMO |
$239.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.12
|
| Rate for Payer: PHCS Commercial |
$306.96
|
| Rate for Payer: United Healthcare All Payer |
$281.38
|
|
|
LARYNGEAL FUNCTION STUDIES(T
|
Facility
|
OP
|
$319.75
|
|
|
Service Code
|
HCPCS 92520
|
| Hospital Charge Code |
761T2452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$306.96 |
| Rate for Payer: Aetna Commercial |
$246.21
|
| Rate for Payer: Anthem Medicaid |
$109.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$159.88
|
| Rate for Payer: Cash Price |
$159.88
|
| Rate for Payer: Cigna Commercial |
$265.39
|
| Rate for Payer: First Health Commercial |
$303.76
|
| Rate for Payer: Humana Commercial |
$271.79
|
| Rate for Payer: Humana KY Medicaid |
$109.96
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$111.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$262.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.38
|
| Rate for Payer: Ohio Health Group HMO |
$239.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.12
|
| Rate for Payer: PHCS Commercial |
$306.96
|
| Rate for Payer: United Healthcare All Payer |
$281.38
|
|
|
LARYNGOSCOP FLEX AIRWAY
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
76101165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.46 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$261.02
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
LARYNGOSCOP FLEX AIRWAY
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
76101165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.46 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem Medicaid |
$289.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$171.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$239.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$231.24
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Humana KY Medicaid |
$289.56
|
| Rate for Payer: Humana Medicare Advantage |
$171.29
|
| Rate for Payer: Kentucky WC Medicaid |
$292.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$261.02
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
LARYNGOSCOP FLEX AIRWAY
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
76101165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$842.00 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.85
|
| Rate for Payer: Anthem Medicaid |
$58.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$842.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$168.18
|
| Rate for Payer: Healthspan PPO |
$137.50
|
| Rate for Payer: Humana Medicaid |
$58.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.20
|
| Rate for Payer: Molina Healthcare Passport |
$58.04
|
| Rate for Payer: Multiplan PHCS |
$505.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$589.40
|
| Rate for Payer: UHCCP Medicaid |
$46.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.62
|
|
|
LARYNGOSCOP FLEX AIRWAY
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
45000216
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
LARYNGOSCOP FLEX AIRWAY
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
45000216
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$171.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$239.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$231.24
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Humana KY Medicaid |
$163.35
|
| Rate for Payer: Humana Medicare Advantage |
$171.29
|
| Rate for Payer: Kentucky WC Medicaid |
$165.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
LARYNGOSCOP FLEX AIRWAY(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
761P1165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.85
|
| Rate for Payer: Anthem Medicaid |
$58.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$168.18
|
| Rate for Payer: Healthspan PPO |
$137.50
|
| Rate for Payer: Humana Medicaid |
$58.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.20
|
| Rate for Payer: Molina Healthcare Passport |
$58.04
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$46.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.62
|
|
|
LARYNGOSCOP FLEX AIRWAY(T
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
761T1165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$472.32 |
| Rate for Payer: Aetna Commercial |
$378.84
|
| Rate for Payer: Anthem Medicaid |
$169.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$171.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$239.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$231.24
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$408.36
|
| Rate for Payer: First Health Commercial |
$467.40
|
| Rate for Payer: Humana Commercial |
$418.20
|
| Rate for Payer: Humana KY Medicaid |
$169.20
|
| Rate for Payer: Humana Medicare Advantage |
$171.29
|
| Rate for Payer: Kentucky WC Medicaid |
$170.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$403.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.96
|
| Rate for Payer: Ohio Health Group HMO |
$369.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.52
|
| Rate for Payer: PHCS Commercial |
$472.32
|
| Rate for Payer: United Healthcare All Payer |
$432.96
|
|
