|
RF LNR 28*70-76 0 DEG L +4
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*70-76 20 DEG L +4
|
Facility
|
IP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*70-76 20 DEG L +4
|
Facility
|
OP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem Medicaid |
$2,292.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Humana KY Medicaid |
$2,292.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RH IG FULL-DOSE IM
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 90384
|
| Hospital Charge Code |
77000006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$394.80 |
| Rate for Payer: Anthem Medicaid |
$53.06
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Healthspan PPO |
$123.57
|
| Rate for Payer: Humana Medicaid |
$53.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$155.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.12
|
| Rate for Payer: Molina Healthcare Passport |
$53.06
|
| Rate for Payer: Multiplan PHCS |
$338.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$394.80
|
| Rate for Payer: UHCCP Medicaid |
$197.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.59
|
|
|
RH IG FULL-DOSE IM
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 90384
|
| Hospital Charge Code |
77000006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem Medicaid |
$193.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Humana KY Medicaid |
$193.96
|
| Rate for Payer: Kentucky WC Medicaid |
$195.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.16
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
RH IG FULL-DOSE IM
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 90384
|
| Hospital Charge Code |
77000006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.16
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
RH IG FULL-DOSE IM(T
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 90384
|
| Hospital Charge Code |
770T0006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem Medicaid |
$193.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Humana KY Medicaid |
$193.96
|
| Rate for Payer: Kentucky WC Medicaid |
$195.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.16
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
RH IG FULL-DOSE IM(T
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 90384
|
| Hospital Charge Code |
770T0006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.16
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
RHINOPLASTY
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 30435
|
| Hospital Charge Code |
76101130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
RHINOPLASTY
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 30430
|
| Hospital Charge Code |
76101129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| 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 |
$5,465.95
|
| 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 |
$6,559.14
|
| 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
|
|
|
RHINOPLASTY
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 30430
|
| Hospital Charge Code |
76101129
|
|
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
|
|
|
RHINOPLASTY
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 30430
|
| Hospital Charge Code |
76101129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.86 |
| Max. Negotiated Rate |
$1,340.27 |
| Rate for Payer: Aetna Commercial |
$1,258.84
|
| Rate for Payer: Ambetter Exchange |
$977.07
|
| Rate for Payer: Anthem Medicaid |
$376.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$977.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$977.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,172.48
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,340.27
|
| Rate for Payer: Healthspan PPO |
$1,061.60
|
| Rate for Payer: Humana Medicaid |
$376.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,144.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$977.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$977.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$384.40
|
| Rate for Payer: Molina Healthcare Passport |
$376.86
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,270.19
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$380.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$977.07
|
|
|
RHINOPLASTY
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 30435
|
| Hospital Charge Code |
76101130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.24 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
RHINOPLASTY
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 30435
|
| Hospital Charge Code |
76101130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,780.91 |
| Rate for Payer: Aetna Commercial |
$1,676.92
|
| Rate for Payer: Ambetter Exchange |
$1,229.26
|
| Rate for Payer: Anthem Medicaid |
$629.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,229.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,229.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,475.11
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,780.91
|
| Rate for Payer: Healthspan PPO |
$1,414.18
|
| Rate for Payer: Humana Medicaid |
$629.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,517.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,229.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$641.62
|
| Rate for Payer: Molina Healthcare Passport |
$629.04
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,598.04
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$635.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,229.26
|
|
|
RHINOPLASTY(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 30435
|
| Hospital Charge Code |
761P1130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,780.91 |
| Rate for Payer: Aetna Commercial |
$1,676.92
|
| Rate for Payer: Ambetter Exchange |
$1,229.26
|
| Rate for Payer: Anthem Medicaid |
$629.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,229.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,229.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,475.11
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,780.91
|
| Rate for Payer: Healthspan PPO |
$1,414.18
|
| Rate for Payer: Humana Medicaid |
$629.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,517.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,229.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$641.62
|
| Rate for Payer: Molina Healthcare Passport |
$629.04
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,598.04
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$635.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,229.26
|
|
|
RHINOPLASTY(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 30430
|
| Hospital Charge Code |
761P1129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.86 |
| Max. Negotiated Rate |
$1,340.27 |
| Rate for Payer: Aetna Commercial |
$1,258.84
|
| Rate for Payer: Ambetter Exchange |
$977.07
|
| Rate for Payer: Anthem Medicaid |
$376.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$977.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$977.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,172.48
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,340.27
|
| Rate for Payer: Healthspan PPO |
$1,061.60
|
| Rate for Payer: Humana Medicaid |
$376.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,144.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$977.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$977.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$384.40
|
| Rate for Payer: Molina Healthcare Passport |
$376.86
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,270.19
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$380.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$977.07
|
|
|
RHINOPLASTY - PRIMARY
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 30420
|
| Hospital Charge Code |
76101128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$982.73 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,946.53
|
| Rate for Payer: Ambetter Exchange |
$1,333.17
|
| Rate for Payer: Anthem Medicaid |
$982.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,333.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,333.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,599.80
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$1,961.50
|
| Rate for Payer: Healthspan PPO |
$1,641.55
|
| Rate for Payer: Humana Medicaid |
$982.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,744.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,333.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,002.38
|
| Rate for Payer: Molina Healthcare Passport |
$982.73
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,733.12
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$992.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,333.17
|
|
|
RHINOPLASTY - PRIMARY
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 30420
|
| Hospital Charge Code |
76101128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,375.60 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
RHINOPLASTY - PRIMARY
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 30420
|
| Hospital Charge Code |
76101128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
RHINOPLASTY PRIMARY
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
76101127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
RHINOPLASTY PRIMARY
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
76101127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.59 |
| Max. Negotiated Rate |
$1,489.89 |
| Rate for Payer: Aetna Commercial |
$1,451.25
|
| Rate for Payer: Ambetter Exchange |
$1,124.08
|
| Rate for Payer: Anthem Medicaid |
$571.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,124.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,124.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,348.90
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,489.89
|
| Rate for Payer: Healthspan PPO |
$1,223.87
|
| Rate for Payer: Humana Medicaid |
$571.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,288.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,124.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,124.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$583.02
|
| Rate for Payer: Molina Healthcare Passport |
$571.59
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,461.30
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$577.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,124.08
|
|
|
RHINOPLASTY PRIMARY
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
76101127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
RHINOPLASTY - PRIMARY(P
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 30420
|
| Hospital Charge Code |
761P1128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$982.73 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,946.53
|
| Rate for Payer: Ambetter Exchange |
$1,333.17
|
| Rate for Payer: Anthem Medicaid |
$982.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,333.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,333.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,599.80
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$1,961.50
|
| Rate for Payer: Healthspan PPO |
$1,641.55
|
| Rate for Payer: Humana Medicaid |
$982.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,744.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,333.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,002.38
|
| Rate for Payer: Molina Healthcare Passport |
$982.73
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,733.12
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$992.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,333.17
|
|
|
RHINOPLASTY PRIMARY(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
761P1127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.59 |
| Max. Negotiated Rate |
$1,489.89 |
| Rate for Payer: Aetna Commercial |
$1,451.25
|
| Rate for Payer: Ambetter Exchange |
$1,124.08
|
| Rate for Payer: Anthem Medicaid |
$571.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,124.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,124.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,348.90
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,489.89
|
| Rate for Payer: Healthspan PPO |
$1,223.87
|
| Rate for Payer: Humana Medicaid |
$571.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,288.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,124.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,124.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$583.02
|
| Rate for Payer: Molina Healthcare Passport |
$571.59
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,461.30
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$577.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,124.08
|
|
|
RHIZOPUS NIGRICANS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000774
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
