|
LARYNGOSCOPY DIRECT(T
|
Facility
|
IP
|
$3,649.58
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
761T1163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$474.45 |
| Max. Negotiated Rate |
$3,503.60 |
| Rate for Payer: Aetna Commercial |
$2,810.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,846.67
|
| Rate for Payer: Cash Price |
$1,824.79
|
| Rate for Payer: Cigna Commercial |
$3,029.15
|
| Rate for Payer: First Health Commercial |
$3,467.10
|
| Rate for Payer: Humana Commercial |
$3,102.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,992.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,693.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,094.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,211.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.37
|
| Rate for Payer: PHCS Commercial |
$3,503.60
|
| Rate for Payer: United Healthcare All Payer |
$3,211.63
|
|
|
LARYNGOSCOPY DIRECT(T
|
Facility
|
OP
|
$3,649.58
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
761T1163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$474.45 |
| Max. Negotiated Rate |
$3,503.60 |
| Rate for Payer: Aetna Commercial |
$2,810.18
|
| Rate for Payer: Anthem Medicaid |
$1,255.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,846.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$1,824.79
|
| Rate for Payer: Cash Price |
$1,824.79
|
| Rate for Payer: Cigna Commercial |
$3,029.15
|
| Rate for Payer: First Health Commercial |
$3,467.10
|
| Rate for Payer: Humana Commercial |
$3,102.14
|
| Rate for Payer: Humana KY Medicaid |
$1,255.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,267.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,992.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,693.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,280.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,211.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.37
|
| Rate for Payer: PHCS Commercial |
$3,503.60
|
| Rate for Payer: United Healthcare All Payer |
$3,211.63
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, EXCEPT NEWBORN
|
Facility
|
OP
|
$2,054.81
|
|
|
Service Code
|
CPT 31525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,467.72 |
| Max. Negotiated Rate |
$2,054.81 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$2,054.81
|
|
|
Service Code
|
CPT 31526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,467.72 |
| Max. Negotiated Rate |
$2,054.81 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, INITIAL
|
Facility
|
OP
|
$4,533.70
|
|
|
Service Code
|
CPT 31528
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,238.36 |
| Max. Negotiated Rate |
$4,533.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,238.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,533.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,371.79
|
| Rate for Payer: Humana Medicare Advantage |
$3,238.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.03
|
|
|
LARYNGOSCOPY FLEX DIAG
|
Facility
|
IP
|
$2,228.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
45000215
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.64 |
| Max. Negotiated Rate |
$2,138.88 |
| Rate for Payer: Aetna Commercial |
$1,715.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.84
|
| Rate for Payer: Cash Price |
$1,114.00
|
| Rate for Payer: Cigna Commercial |
$1,849.24
|
| Rate for Payer: First Health Commercial |
$2,116.60
|
| Rate for Payer: Humana Commercial |
$1,893.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,644.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,960.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,671.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$445.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.68
|
| Rate for Payer: PHCS Commercial |
$2,138.88
|
| Rate for Payer: United Healthcare All Payer |
$1,960.64
|
|
|
LARYNGOSCOPY FLEX DIAG
|
Facility
|
OP
|
$5,918.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
76101164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$769.34 |
| Max. Negotiated Rate |
$5,681.28 |
| Rate for Payer: Aetna Commercial |
$4,556.86
|
| Rate for Payer: Anthem Medicaid |
$2,035.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,616.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cigna Commercial |
$4,911.94
|
| Rate for Payer: First Health Commercial |
$5,622.10
|
| Rate for Payer: Humana Commercial |
$5,030.30
|
| Rate for Payer: Humana KY Medicaid |
$2,035.20
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,055.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,852.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,367.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,076.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,207.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,438.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,834.58
|
| Rate for Payer: PHCS Commercial |
$5,681.28
|
| Rate for Payer: United Healthcare All Payer |
$5,207.84
|
|
|
LARYNGOSCOPY FLEX DIAG
|
Facility
|
IP
|
$5,918.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
76101164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$769.34 |
| Max. Negotiated Rate |
$5,681.28 |
| Rate for Payer: Aetna Commercial |
$4,556.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,616.04
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cigna Commercial |
$4,911.94
|
| Rate for Payer: First Health Commercial |
$5,622.10
|
| Rate for Payer: Humana Commercial |
$5,030.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,852.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,367.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,775.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,207.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,438.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,834.58
|
| Rate for Payer: PHCS Commercial |
$5,681.28
|
| Rate for Payer: United Healthcare All Payer |
$5,207.84
|
|
|
LARYNGOSCOPY FLEX DIAG
|
Professional
|
Both
|
$5,918.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
76101164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.31 |
| Max. Negotiated Rate |
$5,918.00 |
| Rate for Payer: Aetna Commercial |
$301.95
|
| Rate for Payer: Anthem Medicaid |
$206.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,918.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cigna Commercial |
$302.31
|
| Rate for Payer: Healthspan PPO |
$254.64
|
| Rate for Payer: Humana Medicaid |
$206.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$259.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.44
|
| Rate for Payer: Molina Healthcare Passport |
$206.31
|
| Rate for Payer: Multiplan PHCS |
$3,550.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,142.60
|
| Rate for Payer: UHCCP Medicaid |
$2,071.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$208.37
|
|
|
LARYNGOSCOPY FLEX DIAG
|
Facility
|
OP
|
$2,228.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
45000215
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.64 |
| Max. Negotiated Rate |
$2,138.88 |
| Rate for Payer: Aetna Commercial |
$1,715.56
|
| Rate for Payer: Anthem Medicaid |
$766.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$1,114.00
|
| Rate for Payer: Cash Price |
$1,114.00
|
| Rate for Payer: Cigna Commercial |
$1,849.24
|
| Rate for Payer: First Health Commercial |
$2,116.60
|
| Rate for Payer: Humana Commercial |
$1,893.80
|
| Rate for Payer: Humana KY Medicaid |
$766.21
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$774.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,644.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$781.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,960.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,671.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$445.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.68
|
| Rate for Payer: PHCS Commercial |
$2,138.88
|
| Rate for Payer: United Healthcare All Payer |
$1,960.64
|
|
|
LARYNGOSCOPY FLEX DIAG(P
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
761P1164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.31 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$301.95
|
| Rate for Payer: Anthem Medicaid |
$206.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$302.31
|
| Rate for Payer: Healthspan PPO |
$254.64
|
| Rate for Payer: Humana Medicaid |
$206.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$259.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.44
|
| Rate for Payer: Molina Healthcare Passport |
$206.31
|
| Rate for Payer: Multiplan PHCS |
$552.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$644.00
|
| Rate for Payer: UHCCP Medicaid |
$322.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$208.37
|
|
|
LARYNGOSCOPY FLEX DIAG(T
|
Facility
|
OP
|
$4,998.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
761T1164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$4,798.08 |
| Rate for Payer: Aetna Commercial |
$3,848.46
|
| Rate for Payer: Anthem Medicaid |
$1,718.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,898.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cigna Commercial |
$4,148.34
|
| Rate for Payer: First Health Commercial |
$4,748.10
|
| Rate for Payer: Humana Commercial |
$4,248.30
|
| Rate for Payer: Humana KY Medicaid |
$1,718.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,736.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,098.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,688.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,753.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,398.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,748.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$999.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,549.38
|
| Rate for Payer: PHCS Commercial |
$4,798.08
|
| Rate for Payer: United Healthcare All Payer |
$4,398.24
|
|
|
LARYNGOSCOPY FLEX DIAG(T
|
Facility
|
IP
|
$4,998.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
761T1164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$4,798.08 |
| Rate for Payer: Aetna Commercial |
$3,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,898.44
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cigna Commercial |
$4,148.34
|
| Rate for Payer: First Health Commercial |
$4,748.10
|
| Rate for Payer: Humana Commercial |
$4,248.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,098.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,688.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,499.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,398.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,748.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$999.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,549.38
|
| Rate for Payer: PHCS Commercial |
$4,798.08
|
| Rate for Payer: United Healthcare All Payer |
$4,398.24
|
|
|
LARYNGOSCOPY INDIRECT
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
45000213
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$180.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.52
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: Humana Commercial |
$198.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$172.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.92
|
| Rate for Payer: Ohio Health Group HMO |
$175.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.54
|
| Rate for Payer: PHCS Commercial |
$224.64
|
| Rate for Payer: United Healthcare All Payer |
$205.92
|
|
|
LARYNGOSCOPY INDIRECT
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
76101162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Anthem Medicaid |
$278.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$171.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$239.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$231.24
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$672.30
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Humana Commercial |
$688.50
|
| Rate for Payer: Humana KY Medicaid |
$278.56
|
| Rate for Payer: Humana Medicare Advantage |
$171.29
|
| Rate for Payer: Kentucky WC Medicaid |
$281.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$664.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$712.80
|
| Rate for Payer: Ohio Health Group HMO |
$607.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.10
|
| Rate for Payer: PHCS Commercial |
$777.60
|
| Rate for Payer: United Healthcare All Payer |
$712.80
|
|
|
LARYNGOSCOPY INDIRECT
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
76101162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.80
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$672.30
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Humana Commercial |
$688.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$664.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$712.80
|
| Rate for Payer: Ohio Health Group HMO |
$607.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.10
|
| Rate for Payer: PHCS Commercial |
$777.60
|
| Rate for Payer: United Healthcare All Payer |
$712.80
|
|
|
LARYNGOSCOPY INDIRECT
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 31512
|
| Hospital Charge Code |
41000017
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$195.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.24
|
| Rate for Payer: Anthem Medicaid |
$113.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$194.44
|
| Rate for Payer: Healthspan PPO |
$247.90
|
| Rate for Payer: Humana Medicaid |
$113.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$169.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$115.88
|
| Rate for Payer: Molina Healthcare Passport |
$113.61
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$68.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$114.75
|
|
|
LARYNGOSCOPY INDIRECT
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
45000213
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$239.81 |
| Rate for Payer: Aetna Commercial |
$180.18
|
| Rate for Payer: Anthem Medicaid |
$80.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$171.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$239.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$231.24
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: Humana Commercial |
$198.90
|
| Rate for Payer: Humana KY Medicaid |
$80.47
|
| Rate for Payer: Humana Medicare Advantage |
$171.29
|
| Rate for Payer: Kentucky WC Medicaid |
$81.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$172.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.92
|
| Rate for Payer: Ohio Health Group HMO |
$175.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.54
|
| Rate for Payer: PHCS Commercial |
$224.64
|
| Rate for Payer: United Healthcare All Payer |
$205.92
|
|
|
LARYNGOSCOPY INDIRECT
|
Professional
|
Both
|
$810.00
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
76101162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna Commercial |
$70.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.92
|
| Rate for Payer: Anthem Medicaid |
$24.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$810.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$116.56
|
| Rate for Payer: Healthspan PPO |
$96.80
|
| Rate for Payer: Humana Medicaid |
$24.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.38
|
| Rate for Payer: Molina Healthcare Passport |
$24.88
|
| Rate for Payer: Multiplan PHCS |
$486.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$567.00
|
| Rate for Payer: UHCCP Medicaid |
$26.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.13
|
|
|
LARYNGOSCOPY INDIRECT(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
761P1162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$70.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.92
|
| Rate for Payer: Anthem Medicaid |
$24.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$116.56
|
| Rate for Payer: Healthspan PPO |
$96.80
|
| Rate for Payer: Humana Medicaid |
$24.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.38
|
| Rate for Payer: Molina Healthcare Passport |
$24.88
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$26.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.13
|
|
|
LARYNGOSCOPY INDIRECT(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 31512
|
| Hospital Charge Code |
410P0017
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$195.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.24
|
| Rate for Payer: Anthem Medicaid |
$113.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$194.44
|
| Rate for Payer: Healthspan PPO |
$247.90
|
| Rate for Payer: Humana Medicaid |
$113.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$169.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$115.88
|
| Rate for Payer: Molina Healthcare Passport |
$113.61
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$68.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$114.75
|
|
|
LARYNGOSCOPY INDIRECT(T
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
761T1162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem Medicaid |
$123.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$171.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$239.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$231.24
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Humana KY Medicaid |
$123.80
|
| Rate for Payer: Humana Medicare Advantage |
$171.29
|
| Rate for Payer: Kentucky WC Medicaid |
$125.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.60
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
LARYNGOSCOPY INDIRECT(T
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
761T1162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.60
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
LARYNGOSCOPY(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 31540
|
| Hospital Charge Code |
410P0023
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$277.90 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$370.00
|
| Rate for Payer: Anthem Medicaid |
$277.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$374.09
|
| Rate for Payer: Healthspan PPO |
$312.03
|
| Rate for Payer: Humana Medicaid |
$277.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$319.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$283.46
|
| Rate for Payer: Molina Healthcare Passport |
$277.90
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$280.68
|
|
|
LARYNGOSCOPY(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 31511
|
| Hospital Charge Code |
410P0016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.14 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$195.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.14
|
| Rate for Payer: Anthem Medicaid |
$91.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$186.84
|
| Rate for Payer: Healthspan PPO |
$251.52
|
| Rate for Payer: Humana Medicaid |
$91.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$166.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.39
|
| Rate for Payer: Molina Healthcare Passport |
$91.56
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$70.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.48
|
|
