|
NASAL ENDO W/BIOPSY
|
Facility
|
IP
|
$5,478.77
|
|
|
Service Code
|
HCPCS 31237
|
| Hospital Charge Code |
76101148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,643.63 |
| Max. Negotiated Rate |
$5,259.62 |
| Rate for Payer: Aetna Commercial |
$4,218.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,273.44
|
| 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: 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 |
$1,643.63
|
| 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
|
|
|
NASAL ENDO W/BIOPSY
|
Professional
|
Both
|
$5,478.77
|
|
|
Service Code
|
HCPCS 31237
|
| Hospital Charge Code |
76101148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.69 |
| Max. Negotiated Rate |
$3,287.26 |
| Rate for Payer: Aetna Commercial |
$275.47
|
| Rate for Payer: Ambetter Exchange |
$151.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$83.69
|
| Rate for Payer: Anthem Medicaid |
$144.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$151.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$181.62
|
| Rate for Payer: Cash Price |
$2,739.39
|
| Rate for Payer: Cash Price |
$2,739.39
|
| Rate for Payer: Cigna Commercial |
$463.25
|
| Rate for Payer: Healthspan PPO |
$385.76
|
| Rate for Payer: Humana Medicaid |
$144.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$235.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$151.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$147.76
|
| Rate for Payer: Molina Healthcare Passport |
$144.86
|
| Rate for Payer: Multiplan PHCS |
$3,287.26
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.75
|
| Rate for Payer: UHCCP Medicaid |
$87.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$151.35
|
|
|
NASAL ENDO W/BIOPSY(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 31237
|
| Hospital Charge Code |
761P1148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.69 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$275.47
|
| Rate for Payer: Ambetter Exchange |
$151.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$83.69
|
| Rate for Payer: Anthem Medicaid |
$144.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$151.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$181.62
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$463.25
|
| Rate for Payer: Healthspan PPO |
$385.76
|
| Rate for Payer: Humana Medicaid |
$144.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$235.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$151.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$147.76
|
| Rate for Payer: Molina Healthcare Passport |
$144.86
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.75
|
| Rate for Payer: UHCCP Medicaid |
$87.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$151.35
|
|
|
NASAL ENDO W/BIOPSY(T
|
Facility
|
OP
|
$4,178.77
|
|
|
Service Code
|
HCPCS 31237
|
| Hospital Charge Code |
761T1148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,437.08 |
| Max. Negotiated Rate |
$4,011.62 |
| Rate for Payer: Aetna Commercial |
$3,217.65
|
| Rate for Payer: Anthem Medicaid |
$1,437.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,259.44
|
| 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 |
$2,089.39
|
| Rate for Payer: Cash Price |
$2,089.39
|
| Rate for Payer: Cigna Commercial |
$3,468.38
|
| Rate for Payer: First Health Commercial |
$3,969.83
|
| Rate for Payer: Humana Commercial |
$3,551.95
|
| Rate for Payer: Humana KY Medicaid |
$1,437.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,451.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,426.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,083.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,465.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,677.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,134.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,343.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,883.35
|
| Rate for Payer: PHCS Commercial |
$4,011.62
|
| Rate for Payer: United Healthcare All Payer |
$3,677.32
|
|
|
NASAL ENDO W/BIOPSY(T
|
Facility
|
IP
|
$4,178.77
|
|
|
Service Code
|
HCPCS 31237
|
| Hospital Charge Code |
761T1148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,253.63 |
| Max. Negotiated Rate |
$4,011.62 |
| Rate for Payer: Aetna Commercial |
$3,217.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,259.44
|
| Rate for Payer: Cash Price |
$2,089.39
|
| Rate for Payer: Cigna Commercial |
$3,468.38
|
| Rate for Payer: First Health Commercial |
$3,969.83
|
| Rate for Payer: Humana Commercial |
$3,551.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,426.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,083.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,677.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,134.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,343.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,883.35
|
| Rate for Payer: PHCS Commercial |
$4,011.62
|
| Rate for Payer: United Healthcare All Payer |
$3,677.32
|
|
|
NASAL/SINUS ENDO
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 31276
|
| Hospital Charge Code |
76101157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,954.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,634.90
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
NASAL/SINUS ENDO
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 31276
|
| Hospital Charge Code |
76101157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
NASAL/SINUS ENDO
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 31276
|
| Hospital Charge Code |
76101157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.28 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$786.16
|
| Rate for Payer: Ambetter Exchange |
$356.28
|
| Rate for Payer: Anthem Medicaid |
$457.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$356.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$356.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$427.54
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$794.26
|
| Rate for Payer: Healthspan PPO |
$662.99
|
| Rate for Payer: Humana Medicaid |
$457.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$662.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$356.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$356.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$466.82
|
| Rate for Payer: Molina Healthcare Passport |
$457.67
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$463.16
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$462.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$356.28
|
|
|
NASAL/SINUS ENDO(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 31276
|
| Hospital Charge Code |
761P1157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.28 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$786.16
|
| Rate for Payer: Ambetter Exchange |
$356.28
|
| Rate for Payer: Anthem Medicaid |
$457.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$356.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$356.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$427.54
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$794.26
|
| Rate for Payer: Healthspan PPO |
$662.99
|
| Rate for Payer: Humana Medicaid |
$457.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$662.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$356.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$356.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$466.82
|
| Rate for Payer: Molina Healthcare Passport |
$457.67
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$463.16
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$462.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$356.28
|
|
|
NASAL SINUS ENDOSCOPY
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 31254
|
| Hospital Charge Code |
76101153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,954.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,634.90
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
NASAL SINUS ENDOSCOPY
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 31254
|
| Hospital Charge Code |
76101153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.22 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$420.33
|
| Rate for Payer: Ambetter Exchange |
$229.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$236.31
|
| Rate for Payer: Anthem Medicaid |
$312.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$229.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$229.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.06
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$424.20
|
| Rate for Payer: Healthspan PPO |
$354.47
|
| Rate for Payer: Humana Medicaid |
$312.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$357.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$229.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$319.06
|
| Rate for Payer: Molina Healthcare Passport |
$312.80
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.99
|
| Rate for Payer: UHCCP Medicaid |
$248.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$315.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$229.22
|
|
|
NASAL SINUS ENDOSCOPY
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 31254
|
| Hospital Charge Code |
76101153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
NASAL/SINUS ENDOSCOPY
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 31287
|
| Hospital Charge Code |
76101158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
NASAL/SINUS ENDOSCOPY
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 31287
|
| Hospital Charge Code |
76101158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.74 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$357.86
|
| Rate for Payer: Ambetter Exchange |
$189.74
|
| Rate for Payer: Anthem Medicaid |
$265.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$189.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$189.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$227.69
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$361.53
|
| Rate for Payer: Healthspan PPO |
$301.79
|
| Rate for Payer: Humana Medicaid |
$265.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$303.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$189.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$270.50
|
| Rate for Payer: Molina Healthcare Passport |
$265.20
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$246.66
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$267.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$189.74
|
|
|
NASAL/SINUS ENDOSCOPY
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 31287
|
| Hospital Charge Code |
76101158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,954.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,634.90
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
NASAL SINUS ENDOSCOPY(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 31254
|
| Hospital Charge Code |
761P1153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.22 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$420.33
|
| Rate for Payer: Ambetter Exchange |
$229.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$236.31
|
| Rate for Payer: Anthem Medicaid |
$312.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$229.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$229.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.06
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$424.20
|
| Rate for Payer: Healthspan PPO |
$354.47
|
| Rate for Payer: Humana Medicaid |
$312.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$357.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$229.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$319.06
|
| Rate for Payer: Molina Healthcare Passport |
$312.80
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.99
|
| Rate for Payer: UHCCP Medicaid |
$248.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$315.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$229.22
|
|
|
NASAL/SINUS ENDOSCOPY(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 31287
|
| Hospital Charge Code |
761P1158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.74 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$357.86
|
| Rate for Payer: Ambetter Exchange |
$189.74
|
| Rate for Payer: Anthem Medicaid |
$265.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$189.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$189.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$227.69
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$361.53
|
| Rate for Payer: Healthspan PPO |
$301.79
|
| Rate for Payer: Humana Medicaid |
$265.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$303.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$189.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$270.50
|
| Rate for Payer: Molina Healthcare Passport |
$265.20
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$246.66
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$267.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$189.74
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 31240
|
| Hospital Charge Code |
76101150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.35
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 31240
|
| Hospital Charge Code |
76101150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.89 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem Medicaid |
$245.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| 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 |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Humana KY Medicaid |
$245.89
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$248.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.35
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 31240
|
| Hospital Charge Code |
76101150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.20 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Ambetter Exchange |
$150.20
|
| Rate for Payer: Anthem Medicaid |
$175.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$150.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$180.24
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$246.29
|
| Rate for Payer: Healthspan PPO |
$206.02
|
| Rate for Payer: Humana Medicaid |
$175.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$209.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$150.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.66
|
| Rate for Payer: Molina Healthcare Passport |
$175.16
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$195.26
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$150.20
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,230.73
|
|
|
Service Code
|
CPT 31237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,593.38 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF NASAL HEMORRHAGE
|
Facility
|
OP
|
$2,230.73
|
|
|
Service Code
|
CPT 31238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,593.38 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; PARTIAL (ANTERIOR)
|
Facility
|
OP
|
$8,954.71
|
|
|
Service Code
|
CPT 31254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,396.22 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,954.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,634.90
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING FRONTAL SINUS EXPLORATION, WITH REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$8,954.71
|
|
|
Service Code
|
CPT 31253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,396.22 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,954.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,634.90
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH LIGATION OF SPHENOPALATINE ARTERY
|
Facility
|
OP
|
$2,230.73
|
|
|
Service Code
|
CPT 31241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,593.38 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
|
