|
CONTROL NASL HEM POSTERI INITI
|
Facility
|
IP
|
$912.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
76101140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$875.52 |
| Rate for Payer: Aetna Commercial |
$702.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$711.36
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$756.96
|
| Rate for Payer: First Health Commercial |
$866.40
|
| Rate for Payer: Humana Commercial |
$775.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$673.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$802.56
|
| Rate for Payer: Ohio Health Group HMO |
$684.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.72
|
| Rate for Payer: PHCS Commercial |
$875.52
|
| Rate for Payer: United Healthcare All Payer |
$802.56
|
|
|
CONTROL NASL HEM POSTERI INITI
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
761T1140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$443.52 |
| Rate for Payer: Aetna Commercial |
$355.74
|
| Rate for Payer: Anthem Medicaid |
$158.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$383.46
|
| Rate for Payer: First Health Commercial |
$438.90
|
| Rate for Payer: Humana Commercial |
$392.70
|
| Rate for Payer: Humana KY Medicaid |
$158.88
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$160.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$406.56
|
| Rate for Payer: Ohio Health Group HMO |
$346.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.22
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
CONTROL NASL HEM POSTERI INITI
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
45000210
|
|
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 NASL HEM POSTERI INITI
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
761T1140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$443.52 |
| Rate for Payer: Aetna Commercial |
$355.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.36
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$383.46
|
| Rate for Payer: First Health Commercial |
$438.90
|
| Rate for Payer: Humana Commercial |
$392.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$406.56
|
| Rate for Payer: Ohio Health Group HMO |
$346.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.22
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
CONTROL NASL HEM POSTERI INITI
|
Facility
|
OP
|
$912.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
76101140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.46 |
| Max. Negotiated Rate |
$875.52 |
| Rate for Payer: Aetna Commercial |
$702.24
|
| Rate for Payer: Anthem Medicaid |
$313.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$711.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$756.96
|
| Rate for Payer: First Health Commercial |
$866.40
|
| Rate for Payer: Humana Commercial |
$775.20
|
| Rate for Payer: Humana KY Medicaid |
$313.64
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$316.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$673.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$802.56
|
| Rate for Payer: Ohio Health Group HMO |
$684.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.72
|
| Rate for Payer: PHCS Commercial |
$875.52
|
| Rate for Payer: United Healthcare All Payer |
$802.56
|
|
|
CONTROL NASL HEM POSTERI INITI
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
45000210
|
|
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 NASL HEM POSTERI INITI
|
Professional
|
Both
|
$912.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
76101140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.79 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$157.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.79
|
| Rate for Payer: Anthem Medicaid |
$109.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$912.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$156.17
|
| Rate for Payer: Healthspan PPO |
$277.18
|
| Rate for Payer: Humana Medicaid |
$109.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.15
|
| Rate for Payer: Molina Healthcare Passport |
$109.95
|
| Rate for Payer: Multiplan PHCS |
$547.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$638.40
|
| Rate for Payer: UHCCP Medicaid |
$78.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.05
|
|
|
CONTROL NASL HEM POSTERI INITI
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
761P1140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.79 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$157.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.79
|
| Rate for Payer: Anthem Medicaid |
$109.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$156.17
|
| Rate for Payer: Healthspan PPO |
$277.18
|
| Rate for Payer: Humana Medicaid |
$109.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.15
|
| Rate for Payer: Molina Healthcare Passport |
$109.95
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$78.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.05
|
|
|
CONTROL OF NASOPHARY HEMORR
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
76102561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
CONTROL OF NASOPHARY HEMORR
|
Facility
|
OP
|
$4,502.00
|
|
|
Service Code
|
HCPCS 42972
|
| Hospital Charge Code |
76101717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.26 |
| Max. Negotiated Rate |
$4,321.92 |
| Rate for Payer: Aetna Commercial |
$3,466.54
|
| Rate for Payer: Anthem Medicaid |
$1,548.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cigna Commercial |
$3,736.66
|
| Rate for Payer: First Health Commercial |
$4,276.90
|
| Rate for Payer: Humana Commercial |
$3,826.70
|
| Rate for Payer: Humana KY Medicaid |
$1,548.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,563.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.62
|
| Rate for Payer: PHCS Commercial |
$4,321.92
|
| Rate for Payer: United Healthcare All Payer |
$3,961.76
|
|
|
CONTROL OF NASOPHARY HEMORR
|
Facility
|
IP
|
$400.00
|
|
| Hospital Charge Code |
76102561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
CONTROL OF NASOPHARY HEMORR
|
Facility
|
IP
|
$4,502.00
|
|
|
Service Code
|
HCPCS 42972
|
| Hospital Charge Code |
76101717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.26 |
| Max. Negotiated Rate |
$4,321.92 |
| Rate for Payer: Aetna Commercial |
$3,466.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.56
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cigna Commercial |
$3,736.66
|
| Rate for Payer: First Health Commercial |
$4,276.90
|
| Rate for Payer: Humana Commercial |
$3,826.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.62
|
| Rate for Payer: PHCS Commercial |
$4,321.92
|
| Rate for Payer: United Healthcare All Payer |
$3,961.76
|
|
|
CONTROL OF NASOPHARY HEMORR
|
Professional
|
Both
|
$4,502.00
|
|
|
Service Code
|
HCPCS 42972
|
| Hospital Charge Code |
76101717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.98 |
| Max. Negotiated Rate |
$4,502.00 |
| Rate for Payer: Aetna Commercial |
$751.81
|
| Rate for Payer: Anthem Medicaid |
$331.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,502.00
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cigna Commercial |
$751.71
|
| Rate for Payer: Healthspan PPO |
$634.01
|
| Rate for Payer: Humana Medicaid |
$331.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$663.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$338.62
|
| Rate for Payer: Molina Healthcare Passport |
$331.98
|
| Rate for Payer: Multiplan PHCS |
$2,701.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,151.40
|
| Rate for Payer: UHCCP Medicaid |
$1,575.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.30
|
|
|
CONTROL OF NASOPHARY HEMORR
|
Facility
|
IP
|
$417.00
|
|
| Hospital Charge Code |
45000333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
CONTROL OF NASOPHARY HEMORR
|
Facility
|
OP
|
$417.00
|
|
| Hospital Charge Code |
45000333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
CONTROL OF NASOPHARY HEMORR(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 42972
|
| Hospital Charge Code |
761P1717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$751.81 |
| Rate for Payer: Aetna Commercial |
$751.81
|
| Rate for Payer: Anthem Medicaid |
$331.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$751.71
|
| Rate for Payer: Healthspan PPO |
$634.01
|
| Rate for Payer: Humana Medicaid |
$331.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$663.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$338.62
|
| Rate for Payer: Molina Healthcare Passport |
$331.98
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.30
|
|
|
CONTROL OF NASOPHARY HEMORR(T
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 42972
|
| Hospital Charge Code |
761T1717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
CONTROL OF NASOPHARY HEMORR(T
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 42972
|
| Hospital Charge Code |
761T1717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Humana KY Medicaid |
$1,290.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,303.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); WITH SECONDARY SURGICAL INTERVENTION
|
Facility
|
OP
|
$3,897.84
|
|
|
Service Code
|
CPT 42962
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,784.17 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
|
|
CONTROL OROPH HEMORR COMPLICAT
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS 42961
|
| Hospital Charge Code |
76101715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem Medicaid |
$197.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Humana KY Medicaid |
$197.74
|
| Rate for Payer: Kentucky WC Medicaid |
$199.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.25
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
CONTROL OROPH HEMORR COMPLICAT
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 42961
|
| Hospital Charge Code |
76101715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.25 |
| Max. Negotiated Rate |
$609.40 |
| Rate for Payer: Aetna Commercial |
$609.40
|
| Rate for Payer: Anthem Medicaid |
$203.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$575.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$605.67
|
| Rate for Payer: Healthspan PPO |
$513.92
|
| Rate for Payer: Humana Medicaid |
$203.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$543.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.62
|
| Rate for Payer: Molina Healthcare Passport |
$203.55
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.50
|
| Rate for Payer: UHCCP Medicaid |
$201.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.59
|
|
|
CONTROL OROPH HEMORR COMPLICAT
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS 42961
|
| Hospital Charge Code |
76101715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.25
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
CONTROL OROPH HEMORR COMPLICAT
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 42961
|
| Hospital Charge Code |
761P1715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.25 |
| Max. Negotiated Rate |
$609.40 |
| Rate for Payer: Aetna Commercial |
$609.40
|
| Rate for Payer: Anthem Medicaid |
$203.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$575.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$605.67
|
| Rate for Payer: Healthspan PPO |
$513.92
|
| Rate for Payer: Humana Medicaid |
$203.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$543.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.62
|
| Rate for Payer: Molina Healthcare Passport |
$203.55
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.50
|
| Rate for Payer: UHCCP Medicaid |
$201.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.59
|
|
|
CONTROL OROPH HEMORR SURGICAL
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
76101716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$756.61 |
| Rate for Payer: Aetna Commercial |
$756.61
|
| Rate for Payer: Anthem Medicaid |
$371.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$750.30
|
| Rate for Payer: Healthspan PPO |
$638.06
|
| Rate for Payer: Humana Medicaid |
$371.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$671.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.20
|
| Rate for Payer: Molina Healthcare Passport |
$371.76
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.48
|
|
|
CONTROL OROPH HEMORR SURGICAL
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
76101716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
