|
CONTRAST BATH - 15 MINUTES
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 97034
|
| Hospital Charge Code |
43000010
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.72
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Humana KY Medicaid |
$25.45
|
| Rate for Payer: Kentucky WC Medicaid |
$25.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
CONTROL NASAL HEM ANTER SIMPL
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
45000208
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$342.72 |
| Rate for Payer: Aetna Commercial |
$274.89
|
| Rate for Payer: Anthem Medicaid |
$122.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$278.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$296.31
|
| Rate for Payer: First Health Commercial |
$339.15
|
| Rate for Payer: Humana Commercial |
$303.45
|
| Rate for Payer: Humana KY Medicaid |
$122.77
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$124.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$292.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$263.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$125.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$314.16
|
| Rate for Payer: Ohio Health Group HMO |
$267.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.67
|
| Rate for Payer: PHCS Commercial |
$342.72
|
| Rate for Payer: United Healthcare All Payer |
$314.16
|
|
|
CONTROL NASAL HEM ANTER SIMPL
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
76101138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$538.56 |
| Rate for Payer: Aetna Commercial |
$431.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.58
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$465.63
|
| Rate for Payer: First Health Commercial |
$532.95
|
| Rate for Payer: Humana Commercial |
$476.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.68
|
| Rate for Payer: Ohio Health Group HMO |
$420.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.91
|
| Rate for Payer: PHCS Commercial |
$538.56
|
| Rate for Payer: United Healthcare All Payer |
$493.68
|
|
|
CONTROL NASAL HEM ANTER SIMPL
|
Professional
|
Both
|
$561.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
76101138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$561.00 |
| Rate for Payer: Aetna Commercial |
$94.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.90
|
| Rate for Payer: Anthem Medicaid |
$44.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$561.00
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$147.11
|
| Rate for Payer: Healthspan PPO |
$123.74
|
| Rate for Payer: Humana Medicaid |
$44.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.36
|
| Rate for Payer: Molina Healthcare Passport |
$44.47
|
| Rate for Payer: Multiplan PHCS |
$336.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.70
|
| Rate for Payer: UHCCP Medicaid |
$30.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.91
|
|
|
CONTROL NASAL HEM ANTER SIMPL
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
45000208
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$342.72 |
| Rate for Payer: Aetna Commercial |
$274.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$278.46
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$296.31
|
| Rate for Payer: First Health Commercial |
$339.15
|
| Rate for Payer: Humana Commercial |
$303.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$292.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$263.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$314.16
|
| Rate for Payer: Ohio Health Group HMO |
$267.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.67
|
| Rate for Payer: PHCS Commercial |
$342.72
|
| Rate for Payer: United Healthcare All Payer |
$314.16
|
|
|
CONTROL NASAL HEM ANTER SIMPL
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
76101138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$538.56 |
| Rate for Payer: Aetna Commercial |
$431.97
|
| Rate for Payer: Anthem Medicaid |
$192.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$465.63
|
| Rate for Payer: First Health Commercial |
$532.95
|
| Rate for Payer: Humana Commercial |
$476.85
|
| Rate for Payer: Humana KY Medicaid |
$192.93
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$194.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.68
|
| Rate for Payer: Ohio Health Group HMO |
$420.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.91
|
| Rate for Payer: PHCS Commercial |
$538.56
|
| Rate for Payer: United Healthcare All Payer |
$493.68
|
|
|
CONTROL NASAL HEM ANTER SIMP(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
761P1138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$94.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.90
|
| Rate for Payer: Anthem Medicaid |
$44.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$147.11
|
| Rate for Payer: Healthspan PPO |
$123.74
|
| Rate for Payer: Humana Medicaid |
$44.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.36
|
| Rate for Payer: Molina Healthcare Passport |
$44.47
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$30.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.91
|
|
|
CONTROL NASAL HEM ANTER SIMP(T
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
761T1138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$394.56 |
| Rate for Payer: Aetna Commercial |
$316.47
|
| Rate for Payer: Anthem Medicaid |
$141.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$320.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$341.13
|
| Rate for Payer: First Health Commercial |
$390.45
|
| Rate for Payer: Humana Commercial |
$349.35
|
| Rate for Payer: Humana KY Medicaid |
$141.34
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$142.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$303.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$144.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$361.68
|
| Rate for Payer: Ohio Health Group HMO |
$308.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.41
|
| Rate for Payer: PHCS Commercial |
$394.56
|
| Rate for Payer: United Healthcare All Payer |
$361.68
|
|
|
CONTROL NASAL HEM ANTER SIMP(T
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
761T1138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$394.56 |
| Rate for Payer: Aetna Commercial |
$316.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$320.58
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$341.13
|
| Rate for Payer: First Health Commercial |
$390.45
|
| Rate for Payer: Humana Commercial |
$349.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$303.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$361.68
|
| Rate for Payer: Ohio Health Group HMO |
$308.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.41
|
| Rate for Payer: PHCS Commercial |
$394.56
|
| Rate for Payer: United Healthcare All Payer |
$361.68
|
|
|
CONTROL NASAL HEMORR
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
45000211
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$304.32 |
| Rate for Payer: Aetna Commercial |
$244.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$247.26
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$263.11
|
| Rate for Payer: First Health Commercial |
$301.15
|
| Rate for Payer: Humana Commercial |
$269.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$259.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$233.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$278.96
|
| Rate for Payer: Ohio Health Group HMO |
$237.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$98.27
|
| Rate for Payer: PHCS Commercial |
$304.32
|
| Rate for Payer: United Healthcare All Payer |
$278.96
|
|
|
CONTROL NASAL HEMORR
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
76101141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$826.56 |
| Rate for Payer: Aetna Commercial |
$662.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$714.63
|
| Rate for Payer: First Health Commercial |
$817.95
|
| Rate for Payer: Humana Commercial |
$731.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$635.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$757.68
|
| Rate for Payer: Ohio Health Group HMO |
$645.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.91
|
| Rate for Payer: PHCS Commercial |
$826.56
|
| Rate for Payer: United Healthcare All Payer |
$757.68
|
|
|
CONTROL NASAL HEMORR
|
Professional
|
Both
|
$861.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
76101141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.21 |
| Max. Negotiated Rate |
$861.00 |
| Rate for Payer: Aetna Commercial |
$204.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.21
|
| Rate for Payer: Anthem Medicaid |
$103.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$861.00
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$366.14
|
| Rate for Payer: Healthspan PPO |
$319.50
|
| Rate for Payer: Humana Medicaid |
$103.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.60
|
| Rate for Payer: Molina Healthcare Passport |
$103.53
|
| Rate for Payer: Multiplan PHCS |
$516.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$602.70
|
| Rate for Payer: UHCCP Medicaid |
$72.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.57
|
|
|
CONTROL NASAL HEMORR
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
76101141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$826.56 |
| Rate for Payer: Aetna Commercial |
$662.97
|
| Rate for Payer: Anthem Medicaid |
$296.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$714.63
|
| Rate for Payer: First Health Commercial |
$817.95
|
| Rate for Payer: Humana Commercial |
$731.85
|
| Rate for Payer: Humana KY Medicaid |
$296.10
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$299.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$635.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$757.68
|
| Rate for Payer: Ohio Health Group HMO |
$645.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.91
|
| Rate for Payer: PHCS Commercial |
$826.56
|
| Rate for Payer: United Healthcare All Payer |
$757.68
|
|
|
CONTROL NASAL HEMORR
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
45000211
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$304.32 |
| Rate for Payer: Aetna Commercial |
$244.09
|
| Rate for Payer: Anthem Medicaid |
$109.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$247.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$263.11
|
| Rate for Payer: First Health Commercial |
$301.15
|
| Rate for Payer: Humana Commercial |
$269.45
|
| Rate for Payer: Humana KY Medicaid |
$109.02
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$110.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$259.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$233.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$111.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$278.96
|
| Rate for Payer: Ohio Health Group HMO |
$237.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$98.27
|
| Rate for Payer: PHCS Commercial |
$304.32
|
| Rate for Payer: United Healthcare All Payer |
$278.96
|
|
|
CONTROL NASAL HEMORRHAGE
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
76101139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.08 |
| Max. Negotiated Rate |
$853.00 |
| Rate for Payer: Aetna Commercial |
$122.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.08
|
| Rate for Payer: Anthem Medicaid |
$69.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$853.00
|
| Rate for Payer: Cash Price |
$426.50
|
| Rate for Payer: Cash Price |
$426.50
|
| Rate for Payer: Cigna Commercial |
$250.19
|
| Rate for Payer: Healthspan PPO |
$222.25
|
| Rate for Payer: Humana Medicaid |
$69.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$105.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.33
|
| Rate for Payer: Molina Healthcare Passport |
$69.93
|
| Rate for Payer: Multiplan PHCS |
$511.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$597.10
|
| Rate for Payer: UHCCP Medicaid |
$62.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.63
|
|
|
CONTROL NASAL HEMORRHAGE
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
45000209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.19 |
| Max. Negotiated Rate |
$348.48 |
| Rate for Payer: Aetna Commercial |
$279.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.14
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cigna Commercial |
$301.29
|
| Rate for Payer: First Health Commercial |
$344.85
|
| Rate for Payer: Humana Commercial |
$308.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$297.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$267.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$319.44
|
| Rate for Payer: Ohio Health Group HMO |
$272.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.53
|
| Rate for Payer: PHCS Commercial |
$348.48
|
| Rate for Payer: United Healthcare All Payer |
$319.44
|
|
|
CONTROL NASAL HEMORRHAGE
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
76101139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.46 |
| Max. Negotiated Rate |
$818.88 |
| Rate for Payer: Aetna Commercial |
$656.81
|
| Rate for Payer: Anthem Medicaid |
$293.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$665.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$426.50
|
| Rate for Payer: Cash Price |
$426.50
|
| Rate for Payer: Cigna Commercial |
$707.99
|
| Rate for Payer: First Health Commercial |
$810.35
|
| Rate for Payer: Humana Commercial |
$725.05
|
| Rate for Payer: Humana KY Medicaid |
$293.35
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$296.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$699.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$629.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$299.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$750.64
|
| Rate for Payer: Ohio Health Group HMO |
$639.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$264.43
|
| Rate for Payer: PHCS Commercial |
$818.88
|
| Rate for Payer: United Healthcare All Payer |
$750.64
|
|
|
CONTROL NASAL HEMORRHAGE
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
45000209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.19 |
| Max. Negotiated Rate |
$348.48 |
| Rate for Payer: Aetna Commercial |
$279.51
|
| Rate for Payer: Anthem Medicaid |
$124.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cigna Commercial |
$301.29
|
| Rate for Payer: First Health Commercial |
$344.85
|
| Rate for Payer: Humana Commercial |
$308.55
|
| Rate for Payer: Humana KY Medicaid |
$124.84
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$126.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$297.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$267.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$127.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$319.44
|
| Rate for Payer: Ohio Health Group HMO |
$272.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.53
|
| Rate for Payer: PHCS Commercial |
$348.48
|
| Rate for Payer: United Healthcare All Payer |
$319.44
|
|
|
CONTROL NASAL HEMORRHAGE
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
76101139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.89 |
| Max. Negotiated Rate |
$818.88 |
| Rate for Payer: Aetna Commercial |
$656.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$665.34
|
| Rate for Payer: Cash Price |
$426.50
|
| Rate for Payer: Cigna Commercial |
$707.99
|
| Rate for Payer: First Health Commercial |
$810.35
|
| Rate for Payer: Humana Commercial |
$725.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$699.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$629.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$750.64
|
| Rate for Payer: Ohio Health Group HMO |
$639.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$264.43
|
| Rate for Payer: PHCS Commercial |
$818.88
|
| Rate for Payer: United Healthcare All Payer |
$750.64
|
|
|
CONTROL NASAL HEMORRHAGE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
761P1139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.08 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$122.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.08
|
| Rate for Payer: Anthem Medicaid |
$69.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$250.19
|
| Rate for Payer: Healthspan PPO |
$222.25
|
| Rate for Payer: Humana Medicaid |
$69.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$105.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.33
|
| Rate for Payer: Molina Healthcare Passport |
$69.93
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$62.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.63
|
|
|
CONTROL NASAL HEMORRHAGE(T
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
761T1139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.89 |
| Max. Negotiated Rate |
$434.88 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem Medicaid |
$155.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Humana KY Medicaid |
$155.79
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$157.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.43
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
CONTROL NASAL HEMORRHAGE(T
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
761T1139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.89 |
| Max. Negotiated Rate |
$434.88 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.43
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
CONTROL NASAL HEMORR(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
761P1141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.21 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$204.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.21
|
| Rate for Payer: Anthem Medicaid |
$103.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$366.14
|
| Rate for Payer: Healthspan PPO |
$319.50
|
| Rate for Payer: Humana Medicaid |
$103.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.60
|
| Rate for Payer: Molina Healthcare Passport |
$103.53
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$72.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.57
|
|
|
CONTROL NASAL HEMORR(T
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
761T1141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.93 |
| Max. Negotiated Rate |
$442.56 |
| Rate for Payer: Aetna Commercial |
$354.97
|
| Rate for Payer: Anthem Medicaid |
$158.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$359.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$230.50
|
| Rate for Payer: Cash Price |
$230.50
|
| Rate for Payer: Cigna Commercial |
$382.63
|
| Rate for Payer: First Health Commercial |
$437.95
|
| Rate for Payer: Humana Commercial |
$391.85
|
| Rate for Payer: Humana KY Medicaid |
$158.54
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$160.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$405.68
|
| Rate for Payer: Ohio Health Group HMO |
$345.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.91
|
| Rate for Payer: PHCS Commercial |
$442.56
|
| Rate for Payer: United Healthcare All Payer |
$405.68
|
|
|
CONTROL NASAL HEMORR(T
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
761T1141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.93 |
| Max. Negotiated Rate |
$442.56 |
| Rate for Payer: Aetna Commercial |
$354.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$359.58
|
| Rate for Payer: Cash Price |
$230.50
|
| Rate for Payer: Cigna Commercial |
$382.63
|
| Rate for Payer: First Health Commercial |
$437.95
|
| Rate for Payer: Humana Commercial |
$391.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$405.68
|
| Rate for Payer: Ohio Health Group HMO |
$345.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.91
|
| Rate for Payer: PHCS Commercial |
$442.56
|
| Rate for Payer: United Healthcare All Payer |
$405.68
|
|
