|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;
|
Facility
|
OP
|
$4,769.34
|
|
|
Service Code
|
CPT 31256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,406.67 |
| Max. Negotiated Rate |
$4,769.34 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,406.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,769.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,599.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,406.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,088.00
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY SINUS
|
Facility
|
OP
|
$8,954.71
|
|
|
Service Code
|
CPT 31267
|
|
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 SURG(P
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 31240
|
| Hospital Charge Code |
761P1150
|
|
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
|
|
|
NASO/ORO GASTRIC TUBE PLCMT
|
Professional
|
Both
|
$1,818.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
76101790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$1,090.80 |
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Ambetter Exchange |
$37.79
|
| Rate for Payer: Anthem Medicaid |
$154.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.35
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cigna Commercial |
$58.01
|
| Rate for Payer: Healthspan PPO |
$53.27
|
| Rate for Payer: Humana Medicaid |
$154.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$157.88
|
| Rate for Payer: Molina Healthcare Passport |
$154.78
|
| Rate for Payer: Multiplan PHCS |
$1,090.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.13
|
| Rate for Payer: UHCCP Medicaid |
$636.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.79
|
|
|
NASO/ORO GASTRIC TUBE PLCMT
|
Facility
|
OP
|
$1,818.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
76101790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.70 |
| Max. Negotiated Rate |
$1,745.28 |
| Rate for Payer: Aetna Commercial |
$1,399.86
|
| Rate for Payer: Anthem Medicaid |
$625.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,418.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cigna Commercial |
$1,508.94
|
| Rate for Payer: First Health Commercial |
$1,727.10
|
| Rate for Payer: Humana Commercial |
$1,545.30
|
| Rate for Payer: Humana KY Medicaid |
$625.21
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$631.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,581.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,254.42
|
| Rate for Payer: PHCS Commercial |
$1,745.28
|
| Rate for Payer: United Healthcare All Payer |
$1,599.84
|
|
|
NASO/ORO GASTRIC TUBE PLCMT
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
45000265
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.53 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$475.86
|
| Rate for Payer: Anthem Medicaid |
$212.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$482.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$512.94
|
| Rate for Payer: First Health Commercial |
$587.10
|
| Rate for Payer: Humana Commercial |
$525.30
|
| Rate for Payer: Humana KY Medicaid |
$212.53
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$214.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$506.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$456.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$216.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$543.84
|
| Rate for Payer: Ohio Health Group HMO |
$463.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.42
|
| Rate for Payer: PHCS Commercial |
$593.28
|
| Rate for Payer: United Healthcare All Payer |
$543.84
|
|
|
NASO/ORO GASTRIC TUBE PLCMT
|
Facility
|
IP
|
$1,818.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
76101790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$545.40 |
| Max. Negotiated Rate |
$1,745.28 |
| Rate for Payer: Aetna Commercial |
$1,399.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,418.04
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cigna Commercial |
$1,508.94
|
| Rate for Payer: First Health Commercial |
$1,727.10
|
| Rate for Payer: Humana Commercial |
$1,545.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,581.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,254.42
|
| Rate for Payer: PHCS Commercial |
$1,745.28
|
| Rate for Payer: United Healthcare All Payer |
$1,599.84
|
|
|
NASO/ORO GASTRIC TUBE PLCMT
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
45000265
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.40 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$475.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$482.04
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$512.94
|
| Rate for Payer: First Health Commercial |
$587.10
|
| Rate for Payer: Humana Commercial |
$525.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$506.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$456.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$543.84
|
| Rate for Payer: Ohio Health Group HMO |
$463.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.42
|
| Rate for Payer: PHCS Commercial |
$593.28
|
| Rate for Payer: United Healthcare All Payer |
$543.84
|
|
|
NASO/ORO GASTRIC TUBE PLCMT(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
761P1790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Ambetter Exchange |
$37.79
|
| Rate for Payer: Anthem Medicaid |
$154.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.35
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$58.01
|
| Rate for Payer: Healthspan PPO |
$53.27
|
| Rate for Payer: Humana Medicaid |
$154.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$157.88
|
| Rate for Payer: Molina Healthcare Passport |
$154.78
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.13
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.79
|
|
|
NASO/ORO GASTRIC TUBE PLCMT(T
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
761T1790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.40 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$475.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$482.04
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$512.94
|
| Rate for Payer: First Health Commercial |
$587.10
|
| Rate for Payer: Humana Commercial |
$525.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$506.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$456.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$543.84
|
| Rate for Payer: Ohio Health Group HMO |
$463.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.42
|
| Rate for Payer: PHCS Commercial |
$593.28
|
| Rate for Payer: United Healthcare All Payer |
$543.84
|
|
|
NASO/ORO GASTRIC TUBE PLCMT(T
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
761T1790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.53 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$475.86
|
| Rate for Payer: Anthem Medicaid |
$212.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$482.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$512.94
|
| Rate for Payer: First Health Commercial |
$587.10
|
| Rate for Payer: Humana Commercial |
$525.30
|
| Rate for Payer: Humana KY Medicaid |
$212.53
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$214.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$506.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$456.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$216.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$543.84
|
| Rate for Payer: Ohio Health Group HMO |
$463.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.42
|
| Rate for Payer: PHCS Commercial |
$593.28
|
| Rate for Payer: United Healthcare All Payer |
$543.84
|
|
|
NASOPHARYNGOSCROPY W/ENDO
|
Facility
|
IP
|
$1,157.00
|
|
|
Service Code
|
HCPCS 92511
|
| Hospital Charge Code |
76102450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$347.10 |
| Max. Negotiated Rate |
$1,110.72 |
| Rate for Payer: Aetna Commercial |
$890.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.46
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cigna Commercial |
$960.31
|
| Rate for Payer: First Health Commercial |
$1,099.15
|
| Rate for Payer: Humana Commercial |
$983.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$948.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.16
|
| Rate for Payer: Ohio Health Group HMO |
$867.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$925.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,006.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.33
|
| Rate for Payer: PHCS Commercial |
$1,110.72
|
| Rate for Payer: United Healthcare All Payer |
$1,018.16
|
|
|
NASOPHARYNGOSCROPY W/ENDO
|
Facility
|
OP
|
$1,157.00
|
|
|
Service Code
|
HCPCS 92511
|
| Hospital Charge Code |
76102450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$1,110.72 |
| Rate for Payer: Aetna Commercial |
$890.89
|
| Rate for Payer: Anthem Medicaid |
$397.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$179.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$251.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.16
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cigna Commercial |
$960.31
|
| Rate for Payer: First Health Commercial |
$1,099.15
|
| Rate for Payer: Humana Commercial |
$983.45
|
| Rate for Payer: Humana KY Medicaid |
$397.89
|
| Rate for Payer: Humana Medicare Advantage |
$179.38
|
| Rate for Payer: Kentucky WC Medicaid |
$401.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$948.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.16
|
| Rate for Payer: Ohio Health Group HMO |
$867.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$925.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,006.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.33
|
| Rate for Payer: PHCS Commercial |
$1,110.72
|
| Rate for Payer: United Healthcare All Payer |
$1,018.16
|
|
|
NASOPHARYNGOSCROPY W/ENDO
|
Professional
|
Both
|
$1,157.00
|
|
|
Service Code
|
HCPCS 92511
|
| Hospital Charge Code |
76102450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$694.20 |
| Rate for Payer: Aetna Commercial |
$88.09
|
| Rate for Payer: Ambetter Exchange |
$35.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.62
|
| Rate for Payer: Anthem Medicaid |
$49.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.61
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cigna Commercial |
$229.42
|
| Rate for Payer: Healthspan PPO |
$178.96
|
| Rate for Payer: Humana Medicaid |
$49.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$70.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.62
|
| Rate for Payer: Molina Healthcare Passport |
$49.63
|
| Rate for Payer: Multiplan PHCS |
$694.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.16
|
| Rate for Payer: UHCCP Medicaid |
$25.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.51
|
|
|
NASOPHARYNGOSCROPY W/ENDO(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 92511
|
| Hospital Charge Code |
761P2450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$88.09
|
| Rate for Payer: Ambetter Exchange |
$35.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.62
|
| Rate for Payer: Anthem Medicaid |
$49.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.61
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$229.42
|
| Rate for Payer: Healthspan PPO |
$178.96
|
| Rate for Payer: Humana Medicaid |
$49.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$70.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.62
|
| Rate for Payer: Molina Healthcare Passport |
$49.63
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.16
|
| Rate for Payer: UHCCP Medicaid |
$25.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.51
|
|
|
NASOPHARYNGOSCROPY W/ENDO(T
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
HCPCS 92511
|
| Hospital Charge Code |
761T2450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.97 |
| Max. Negotiated Rate |
$390.72 |
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: Anthem Medicaid |
$139.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$179.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$317.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$251.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.16
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$337.81
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: Humana Commercial |
$345.95
|
| Rate for Payer: Humana KY Medicaid |
$139.97
|
| Rate for Payer: Humana Medicare Advantage |
$179.38
|
| Rate for Payer: Kentucky WC Medicaid |
$141.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$333.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$300.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$142.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$358.16
|
| Rate for Payer: Ohio Health Group HMO |
$305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$325.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$280.83
|
| Rate for Payer: PHCS Commercial |
$390.72
|
| Rate for Payer: United Healthcare All Payer |
$358.16
|
|
|
NASOPHARYNGOSCROPY W/ENDO(T
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
HCPCS 92511
|
| Hospital Charge Code |
761T2450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.10 |
| Max. Negotiated Rate |
$390.72 |
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$317.46
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$337.81
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: Humana Commercial |
$345.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$333.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$300.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$358.16
|
| Rate for Payer: Ohio Health Group HMO |
$305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$325.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$280.83
|
| Rate for Payer: PHCS Commercial |
$390.72
|
| Rate for Payer: United Healthcare All Payer |
$358.16
|
|
|
NASOPHARYNX BX
|
Facility
|
IP
|
$4,124.36
|
|
|
Service Code
|
HCPCS 42804
|
| Hospital Charge Code |
76101700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,237.31 |
| Max. Negotiated Rate |
$3,959.39 |
| Rate for Payer: Aetna Commercial |
$3,175.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.00
|
| Rate for Payer: Cash Price |
$2,062.18
|
| Rate for Payer: Cigna Commercial |
$3,423.22
|
| Rate for Payer: First Health Commercial |
$3,918.14
|
| Rate for Payer: Humana Commercial |
$3,505.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,381.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,043.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,629.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,299.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,588.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,845.81
|
| Rate for Payer: PHCS Commercial |
$3,959.39
|
| Rate for Payer: United Healthcare All Payer |
$3,629.44
|
|
|
NASOPHARYNX BX
|
Facility
|
OP
|
$4,124.36
|
|
|
Service Code
|
HCPCS 42804
|
| Hospital Charge Code |
76101700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,418.37 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,175.76
|
| Rate for Payer: Anthem Medicaid |
$1,418.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,062.18
|
| Rate for Payer: Cash Price |
$2,062.18
|
| Rate for Payer: Cigna Commercial |
$3,423.22
|
| Rate for Payer: First Health Commercial |
$3,918.14
|
| Rate for Payer: Humana Commercial |
$3,505.71
|
| Rate for Payer: Humana KY Medicaid |
$1,418.37
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,432.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,381.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,043.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,446.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,629.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,299.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,588.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,845.81
|
| Rate for Payer: PHCS Commercial |
$3,959.39
|
| Rate for Payer: United Healthcare All Payer |
$3,629.44
|
|
|
NASOPHARYNX BX
|
Professional
|
Both
|
$4,124.36
|
|
|
Service Code
|
HCPCS 42804
|
| Hospital Charge Code |
76101700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$2,474.62 |
| Rate for Payer: Aetna Commercial |
$163.89
|
| Rate for Payer: Ambetter Exchange |
$114.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.56
|
| Rate for Payer: Anthem Medicaid |
$67.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$114.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$114.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.21
|
| Rate for Payer: Cash Price |
$2,062.18
|
| Rate for Payer: Cash Price |
$2,062.18
|
| Rate for Payer: Cigna Commercial |
$167.06
|
| Rate for Payer: Healthspan PPO |
$229.84
|
| Rate for Payer: Humana Medicaid |
$67.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$114.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.66
|
| Rate for Payer: Molina Healthcare Passport |
$67.31
|
| Rate for Payer: Multiplan PHCS |
$2,474.62
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$148.64
|
| Rate for Payer: UHCCP Medicaid |
$77.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$114.34
|
|
|
NASOPHARYNX BX(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 42804
|
| Hospital Charge Code |
761P1700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$229.84 |
| Rate for Payer: Aetna Commercial |
$163.89
|
| Rate for Payer: Ambetter Exchange |
$114.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.56
|
| Rate for Payer: Anthem Medicaid |
$67.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$114.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$114.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.21
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$167.06
|
| Rate for Payer: Healthspan PPO |
$229.84
|
| Rate for Payer: Humana Medicaid |
$67.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$114.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.66
|
| Rate for Payer: Molina Healthcare Passport |
$67.31
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$148.64
|
| Rate for Payer: UHCCP Medicaid |
$77.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$114.34
|
|
|
NASOPHARYNX BX(T
|
Facility
|
OP
|
$3,774.36
|
|
|
Service Code
|
HCPCS 42804
|
| Hospital Charge Code |
761T1700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,298.00 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$2,906.26
|
| Rate for Payer: Anthem Medicaid |
$1,298.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$1,887.18
|
| Rate for Payer: Cash Price |
$1,887.18
|
| Rate for Payer: Cigna Commercial |
$3,132.72
|
| Rate for Payer: First Health Commercial |
$3,585.64
|
| Rate for Payer: Humana Commercial |
$3,208.21
|
| Rate for Payer: Humana KY Medicaid |
$1,298.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,094.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,321.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,830.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,019.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,283.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,604.31
|
| Rate for Payer: PHCS Commercial |
$3,623.39
|
| Rate for Payer: United Healthcare All Payer |
$3,321.44
|
|
|
NASOPHARYNX BX(T
|
Facility
|
IP
|
$3,774.36
|
|
|
Service Code
|
HCPCS 42804
|
| Hospital Charge Code |
761T1700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,132.31 |
| Max. Negotiated Rate |
$3,623.39 |
| Rate for Payer: Aetna Commercial |
$2,906.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.00
|
| Rate for Payer: Cash Price |
$1,887.18
|
| Rate for Payer: Cigna Commercial |
$3,132.72
|
| Rate for Payer: First Health Commercial |
$3,585.64
|
| Rate for Payer: Humana Commercial |
$3,208.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,094.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,321.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,830.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,019.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,283.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,604.31
|
| Rate for Payer: PHCS Commercial |
$3,623.39
|
| Rate for Payer: United Healthcare All Payer |
$3,321.44
|
|
|
NATRELLE 410 BRST IMP LH 310CC
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
NATRELLE 410 BRST IMP LH 310CC
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
