|
NAROPIN (ROPIVACAINE)7.5MG/ML
|
Facility
|
OP
|
$125.90
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002351
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$120.86 |
| Rate for Payer: Aetna Commercial |
$96.94
|
| Rate for Payer: Anthem Medicaid |
$43.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.20
|
| Rate for Payer: Cash Price |
$62.95
|
| Rate for Payer: Cigna Commercial |
$104.50
|
| Rate for Payer: First Health Commercial |
$119.61
|
| Rate for Payer: Humana Commercial |
$107.02
|
| Rate for Payer: Humana KY Medicaid |
$43.30
|
| Rate for Payer: Kentucky WC Medicaid |
$43.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.79
|
| Rate for Payer: Ohio Health Group HMO |
$94.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.87
|
| Rate for Payer: PHCS Commercial |
$120.86
|
| Rate for Payer: United Healthcare All Payer |
$110.79
|
|
|
NASAL BALLOON TAMPONADE
|
Facility
|
OP
|
$5,229.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
76101149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,593.38 |
| Max. Negotiated Rate |
$5,020.44 |
| Rate for Payer: Aetna Commercial |
$4,026.82
|
| Rate for Payer: Anthem Medicaid |
$1,798.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,079.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Cash Price |
$2,614.82
|
| Rate for Payer: Cash Price |
$2,614.82
|
| Rate for Payer: Cigna Commercial |
$4,340.59
|
| Rate for Payer: First Health Commercial |
$4,968.15
|
| Rate for Payer: Humana Commercial |
$4,445.19
|
| Rate for Payer: Humana KY Medicaid |
$1,798.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,816.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,288.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,859.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,834.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,602.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,922.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,183.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,549.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,608.44
|
| Rate for Payer: PHCS Commercial |
$5,020.44
|
| Rate for Payer: United Healthcare All Payer |
$4,602.07
|
|
|
NASAL BALLOON TAMPONADE
|
Facility
|
IP
|
$4,379.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
45000212
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,313.89 |
| Max. Negotiated Rate |
$4,204.44 |
| Rate for Payer: Aetna Commercial |
$3,372.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,416.11
|
| Rate for Payer: Cash Price |
$2,189.82
|
| Rate for Payer: Cigna Commercial |
$3,635.09
|
| Rate for Payer: First Health Commercial |
$4,160.65
|
| Rate for Payer: Humana Commercial |
$3,722.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,591.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,232.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,313.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,854.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,284.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,503.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,810.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,021.94
|
| Rate for Payer: PHCS Commercial |
$4,204.44
|
| Rate for Payer: United Healthcare All Payer |
$3,854.07
|
|
|
NASAL BALLOON TAMPONADE
|
Facility
|
IP
|
$5,229.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
76101149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,568.89 |
| Max. Negotiated Rate |
$5,020.44 |
| Rate for Payer: Aetna Commercial |
$4,026.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,079.11
|
| Rate for Payer: Cash Price |
$2,614.82
|
| Rate for Payer: Cigna Commercial |
$4,340.59
|
| Rate for Payer: First Health Commercial |
$4,968.15
|
| Rate for Payer: Humana Commercial |
$4,445.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,288.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,859.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,568.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,602.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,922.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,183.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,549.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,608.44
|
| Rate for Payer: PHCS Commercial |
$5,020.44
|
| Rate for Payer: United Healthcare All Payer |
$4,602.07
|
|
|
NASAL BALLOON TAMPONADE
|
Professional
|
Both
|
$5,229.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
76101149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.84 |
| Max. Negotiated Rate |
$3,137.78 |
| Rate for Payer: Aetna Commercial |
$297.88
|
| Rate for Payer: Ambetter Exchange |
$157.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.84
|
| Rate for Payer: Anthem Medicaid |
$218.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$189.18
|
| Rate for Payer: Cash Price |
$2,614.82
|
| Rate for Payer: Cash Price |
$2,614.82
|
| Rate for Payer: Cigna Commercial |
$478.36
|
| Rate for Payer: Healthspan PPO |
$397.44
|
| Rate for Payer: Humana Medicaid |
$218.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$256.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$157.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$222.81
|
| Rate for Payer: Molina Healthcare Passport |
$218.44
|
| Rate for Payer: Multiplan PHCS |
$3,137.78
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$204.94
|
| Rate for Payer: UHCCP Medicaid |
$99.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.65
|
|
|
NASAL BALLOON TAMPONADE
|
Facility
|
OP
|
$4,379.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
45000212
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,506.15 |
| Max. Negotiated Rate |
$4,204.44 |
| Rate for Payer: Aetna Commercial |
$3,372.32
|
| Rate for Payer: Anthem Medicaid |
$1,506.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,416.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Cash Price |
$2,189.82
|
| Rate for Payer: Cash Price |
$2,189.82
|
| Rate for Payer: Cigna Commercial |
$3,635.09
|
| Rate for Payer: First Health Commercial |
$4,160.65
|
| Rate for Payer: Humana Commercial |
$3,722.69
|
| Rate for Payer: Humana KY Medicaid |
$1,506.15
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,521.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,591.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,232.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,536.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,854.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,284.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,503.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,810.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,021.94
|
| Rate for Payer: PHCS Commercial |
$4,204.44
|
| Rate for Payer: United Healthcare All Payer |
$3,854.07
|
|
|
NASAL BALLOON TAMPONADE(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
761P1149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.84 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$297.88
|
| Rate for Payer: Ambetter Exchange |
$157.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.84
|
| Rate for Payer: Anthem Medicaid |
$218.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$189.18
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$478.36
|
| Rate for Payer: Healthspan PPO |
$397.44
|
| Rate for Payer: Humana Medicaid |
$218.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$256.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$157.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$222.81
|
| Rate for Payer: Molina Healthcare Passport |
$218.44
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$204.94
|
| Rate for Payer: UHCCP Medicaid |
$99.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.65
|
|
|
NASAL BALLOON TAMPONADE(T
|
Facility
|
IP
|
$4,379.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
761T1149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,313.89 |
| Max. Negotiated Rate |
$4,204.44 |
| Rate for Payer: Aetna Commercial |
$3,372.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,416.11
|
| Rate for Payer: Cash Price |
$2,189.82
|
| Rate for Payer: Cigna Commercial |
$3,635.09
|
| Rate for Payer: First Health Commercial |
$4,160.65
|
| Rate for Payer: Humana Commercial |
$3,722.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,591.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,232.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,313.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,854.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,284.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,503.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,810.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,021.94
|
| Rate for Payer: PHCS Commercial |
$4,204.44
|
| Rate for Payer: United Healthcare All Payer |
$3,854.07
|
|
|
NASAL BALLOON TAMPONADE(T
|
Facility
|
OP
|
$4,379.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
761T1149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,506.15 |
| Max. Negotiated Rate |
$4,204.44 |
| Rate for Payer: Aetna Commercial |
$3,372.32
|
| Rate for Payer: Anthem Medicaid |
$1,506.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,416.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Cash Price |
$2,189.82
|
| Rate for Payer: Cash Price |
$2,189.82
|
| Rate for Payer: Cigna Commercial |
$3,635.09
|
| Rate for Payer: First Health Commercial |
$4,160.65
|
| Rate for Payer: Humana Commercial |
$3,722.69
|
| Rate for Payer: Humana KY Medicaid |
$1,506.15
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,521.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,591.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,232.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,536.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,854.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,284.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,503.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,810.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,021.94
|
| Rate for Payer: PHCS Commercial |
$4,204.44
|
| Rate for Payer: United Healthcare All Payer |
$3,854.07
|
|
|
NASAL BONES 3V
|
Professional
|
Both
|
$478.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$286.80 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Ambetter Exchange |
$33.87
|
| Rate for Payer: Anthem Medicaid |
$21.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.64
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$43.65
|
| Rate for Payer: Healthspan PPO |
$44.79
|
| Rate for Payer: Humana Medicaid |
$21.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare Passport |
$21.52
|
| Rate for Payer: Multiplan PHCS |
$286.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.03
|
| Rate for Payer: UHCCP Medicaid |
$167.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.87
|
|
|
NASAL BONES 3V
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.82
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
NASAL BONES 3V
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Humana KY Medicaid |
$164.38
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$166.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.82
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
NASAL BONES 3V(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
320P0013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$47.80 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Ambetter Exchange |
$33.87
|
| Rate for Payer: Anthem Medicaid |
$21.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.64
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$43.65
|
| Rate for Payer: Healthspan PPO |
$44.79
|
| Rate for Payer: Humana Medicaid |
$21.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare Passport |
$21.52
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.03
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.87
|
|
|
NASAL BONES 3V(T
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
320T0013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
NASAL BONES 3V(T
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
320T0013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem Medicaid |
$147.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Humana KY Medicaid |
$147.19
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$148.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
NASALCROM(CROMOLYN) SPRAY
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 14832001101
|
| Hospital Charge Code |
25001052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem Medicaid |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.06
|
| Rate for Payer: First Health Commercial |
$0.07
|
| Rate for Payer: Humana Commercial |
$0.06
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.06
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.05
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
|
NASALCROM(CROMOLYN) SPRAY
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 14832001101
|
| Hospital Charge Code |
25001052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.06
|
| Rate for Payer: First Health Commercial |
$0.07
|
| Rate for Payer: Humana Commercial |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.06
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.05
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
|
NASAL ENDOSCOPY
|
Facility
|
OP
|
$1,835.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
76101147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$1,761.60 |
| Rate for Payer: Aetna Commercial |
$1,412.95
|
| Rate for Payer: Anthem Medicaid |
$631.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$179.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,431.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$251.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.16
|
| Rate for Payer: Cash Price |
$917.50
|
| Rate for Payer: Cash Price |
$917.50
|
| Rate for Payer: Cigna Commercial |
$1,523.05
|
| Rate for Payer: First Health Commercial |
$1,743.25
|
| Rate for Payer: Humana Commercial |
$1,559.75
|
| Rate for Payer: Humana KY Medicaid |
$631.06
|
| Rate for Payer: Humana Medicare Advantage |
$179.38
|
| Rate for Payer: Kentucky WC Medicaid |
$637.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,504.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,354.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$643.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,614.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,266.15
|
| Rate for Payer: PHCS Commercial |
$1,761.60
|
| Rate for Payer: United Healthcare All Payer |
$1,614.80
|
|
|
NASAL ENDOSCOPY
|
Professional
|
Both
|
$1,835.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
76101147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.36 |
| Max. Negotiated Rate |
$1,101.00 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Ambetter Exchange |
$60.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.36
|
| Rate for Payer: Anthem Medicaid |
$72.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.80
|
| Rate for Payer: Cash Price |
$917.50
|
| Rate for Payer: Cash Price |
$917.50
|
| Rate for Payer: Cigna Commercial |
$255.87
|
| Rate for Payer: Healthspan PPO |
$216.93
|
| Rate for Payer: Humana Medicaid |
$72.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$98.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$60.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.12
|
| Rate for Payer: Molina Healthcare Passport |
$72.67
|
| Rate for Payer: Multiplan PHCS |
$1,101.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.87
|
| Rate for Payer: UHCCP Medicaid |
$33.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.67
|
|
|
NASAL ENDOSCOPY
|
Facility
|
IP
|
$1,835.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
76101147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.50 |
| Max. Negotiated Rate |
$1,761.60 |
| Rate for Payer: Aetna Commercial |
$1,412.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,431.30
|
| Rate for Payer: Cash Price |
$917.50
|
| Rate for Payer: Cigna Commercial |
$1,523.05
|
| Rate for Payer: First Health Commercial |
$1,743.25
|
| Rate for Payer: Humana Commercial |
$1,559.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,504.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,354.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$550.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,614.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,266.15
|
| Rate for Payer: PHCS Commercial |
$1,761.60
|
| Rate for Payer: United Healthcare All Payer |
$1,614.80
|
|
|
NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$251.13
|
|
|
Service Code
|
CPT 31231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$251.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$179.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$251.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.16
|
| Rate for Payer: Humana Medicare Advantage |
$179.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.26
|
|
|
NASAL ENDOSCOPY(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
761P1147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.36 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Ambetter Exchange |
$60.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.36
|
| Rate for Payer: Anthem Medicaid |
$72.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.80
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$255.87
|
| Rate for Payer: Healthspan PPO |
$216.93
|
| Rate for Payer: Humana Medicaid |
$72.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$98.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$60.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.12
|
| Rate for Payer: Molina Healthcare Passport |
$72.67
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.87
|
| Rate for Payer: UHCCP Medicaid |
$33.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.67
|
|
|
NASAL ENDOSCOPY(T
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
761T1147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem Medicaid |
$183.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$179.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$251.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.16
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Humana KY Medicaid |
$183.99
|
| Rate for Payer: Humana Medicare Advantage |
$179.38
|
| Rate for Payer: Kentucky WC Medicaid |
$185.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
NASAL ENDOSCOPY(T
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
761T1147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
NASAL ENDO W/BIOPSY
|
Facility
|
OP
|
$5,478.77
|
|
|
Service Code
|
HCPCS 31237
|
| Hospital Charge Code |
76101148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,593.38 |
| Max. Negotiated Rate |
$5,259.62 |
| Rate for Payer: Aetna Commercial |
$4,218.65
|
| Rate for Payer: Anthem Medicaid |
$1,884.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,273.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Cash Price |
$2,739.39
|
| Rate for Payer: Cash Price |
$2,739.39
|
| Rate for Payer: Cigna Commercial |
$4,547.38
|
| Rate for Payer: First Health Commercial |
$5,204.83
|
| Rate for Payer: Humana Commercial |
$4,656.95
|
| Rate for Payer: Humana KY Medicaid |
$1,884.15
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,903.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,492.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,043.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,921.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,821.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,109.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,383.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,766.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,780.35
|
| Rate for Payer: PHCS Commercial |
$5,259.62
|
| Rate for Payer: United Healthcare All Payer |
$4,821.32
|
|
