|
CONTRAST BATH - 15 MIN
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 97034
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| 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: 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: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
CONTRAST BATH - 15 MIN
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 97034
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.20 |
| 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 |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
CONTRAST BATH - 15 MINUTES
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 97034
|
| Hospital Charge Code |
43000010
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.06
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.13
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
CONTRAST BATH - 15 MINUTES
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 97034
|
| Hospital Charge Code |
43000010
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem Medicaid |
$26.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.06
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Humana KY Medicaid |
$26.48
|
| Rate for Payer: Kentucky WC Medicaid |
$26.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.13
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
CONTROL NASAL HEM ANTER SIMPL
|
Professional
|
Both
|
$587.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
76101138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$352.20 |
| Rate for Payer: Aetna Commercial |
$94.82
|
| Rate for Payer: Ambetter Exchange |
$53.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.90
|
| Rate for Payer: Anthem Medicaid |
$51.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$64.42
|
| Rate for Payer: Cash Price |
$293.50
|
| Rate for Payer: Cash Price |
$293.50
|
| Rate for Payer: Cigna Commercial |
$147.11
|
| Rate for Payer: Healthspan PPO |
$123.74
|
| Rate for Payer: Humana Medicaid |
$51.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.02
|
| Rate for Payer: Molina Healthcare Passport |
$51.98
|
| Rate for Payer: Multiplan PHCS |
$352.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.78
|
| Rate for Payer: UHCCP Medicaid |
$30.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.68
|
|
|
CONTROL NASAL HEM ANTER SIMPL
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
76101138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.10 |
| Max. Negotiated Rate |
$563.52 |
| Rate for Payer: Aetna Commercial |
$451.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$457.86
|
| Rate for Payer: Cash Price |
$293.50
|
| Rate for Payer: Cigna Commercial |
$487.21
|
| Rate for Payer: First Health Commercial |
$557.65
|
| Rate for Payer: Humana Commercial |
$498.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$481.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$516.56
|
| Rate for Payer: Ohio Health Group HMO |
$440.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$469.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$405.03
|
| Rate for Payer: PHCS Commercial |
$563.52
|
| Rate for Payer: United Healthcare All Payer |
$516.56
|
|
|
CONTROL NASAL HEM ANTER SIMPL
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
76101138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$563.52 |
| Rate for Payer: Aetna Commercial |
$451.99
|
| Rate for Payer: Anthem Medicaid |
$201.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$457.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$293.50
|
| Rate for Payer: Cash Price |
$293.50
|
| Rate for Payer: Cigna Commercial |
$487.21
|
| Rate for Payer: First Health Commercial |
$557.65
|
| Rate for Payer: Humana Commercial |
$498.95
|
| Rate for Payer: Humana KY Medicaid |
$201.87
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$203.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$481.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$516.56
|
| Rate for Payer: Ohio Health Group HMO |
$440.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$469.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$405.03
|
| Rate for Payer: PHCS Commercial |
$563.52
|
| Rate for Payer: United Healthcare All Payer |
$516.56
|
|
|
CONTROL NASAL HEM ANTER SIMPL
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
45000208
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.10 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$336.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.86
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$362.71
|
| Rate for Payer: First Health Commercial |
$415.15
|
| Rate for Payer: Humana Commercial |
$371.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.56
|
| Rate for Payer: Ohio Health Group HMO |
$327.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.53
|
| Rate for Payer: PHCS Commercial |
$419.52
|
| Rate for Payer: United Healthcare All Payer |
$384.56
|
|
|
CONTROL NASAL HEM ANTER SIMPL
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
45000208
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$336.49
|
| Rate for Payer: Anthem Medicaid |
$150.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$362.71
|
| Rate for Payer: First Health Commercial |
$415.15
|
| Rate for Payer: Humana Commercial |
$371.45
|
| Rate for Payer: Humana KY Medicaid |
$150.28
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$151.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.56
|
| Rate for Payer: Ohio Health Group HMO |
$327.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.53
|
| Rate for Payer: PHCS Commercial |
$419.52
|
| Rate for Payer: United Healthcare All Payer |
$384.56
|
|
|
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 |
$147.11 |
| Rate for Payer: Aetna Commercial |
$94.82
|
| Rate for Payer: Ambetter Exchange |
$53.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.90
|
| Rate for Payer: Anthem Medicaid |
$51.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$64.42
|
| 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 |
$51.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.02
|
| Rate for Payer: Molina Healthcare Passport |
$51.98
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.78
|
| Rate for Payer: UHCCP Medicaid |
$30.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.68
|
|
|
CONTROL NASAL HEM ANTER SIMP(T
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
761T1138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.10 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$336.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.86
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$362.71
|
| Rate for Payer: First Health Commercial |
$415.15
|
| Rate for Payer: Humana Commercial |
$371.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.56
|
| Rate for Payer: Ohio Health Group HMO |
$327.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.53
|
| Rate for Payer: PHCS Commercial |
$419.52
|
| Rate for Payer: United Healthcare All Payer |
$384.56
|
|
|
CONTROL NASAL HEM ANTER SIMP(T
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
761T1138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$336.49
|
| Rate for Payer: Anthem Medicaid |
$150.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$362.71
|
| Rate for Payer: First Health Commercial |
$415.15
|
| Rate for Payer: Humana Commercial |
$371.45
|
| Rate for Payer: Humana KY Medicaid |
$150.28
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$151.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.56
|
| Rate for Payer: Ohio Health Group HMO |
$327.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.53
|
| Rate for Payer: PHCS Commercial |
$419.52
|
| Rate for Payer: United Healthcare All Payer |
$384.56
|
|
|
CONTROL NASAL HEMORR
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
76101141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.30 |
| 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 |
$688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$749.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.09
|
| Rate for Payer: PHCS Commercial |
$826.56
|
| Rate for Payer: United Healthcare All Payer |
$757.68
|
|
|
CONTROL NASAL HEMORR
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
76101141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| 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 |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| 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 |
$214.57
|
| 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 |
$257.48
|
| 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 |
$688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$749.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.09
|
| Rate for Payer: PHCS Commercial |
$826.56
|
| Rate for Payer: United Healthcare All Payer |
$757.68
|
|
|
CONTROL NASAL HEMORR
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
45000211
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.54 |
| 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 |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$359.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| 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 |
$214.57
|
| 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 |
$257.48
|
| 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 |
$368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.09
|
| Rate for Payer: PHCS Commercial |
$442.56
|
| Rate for Payer: United Healthcare All Payer |
$405.68
|
|
|
CONTROL NASAL HEMORR
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
45000211
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.30 |
| 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 |
$368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.09
|
| Rate for Payer: PHCS Commercial |
$442.56
|
| Rate for Payer: United Healthcare All Payer |
$405.68
|
|
|
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 |
$516.60 |
| Rate for Payer: Aetna Commercial |
$204.92
|
| Rate for Payer: Ambetter Exchange |
$125.44
|
| 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 Individual/Medicaid |
$125.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.53
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$125.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.44
|
| 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 |
$163.07
|
| Rate for Payer: UHCCP Medicaid |
$72.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.44
|
|
|
CONTROL NASAL HEMORRHAGE
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
45000209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.90 |
| 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 |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.57
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
CONTROL NASAL HEMORRHAGE
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
45000209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.10 |
| 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 |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| 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 |
$119.10
|
| 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 |
$142.92
|
| 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 |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.57
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
CONTROL NASAL HEMORRHAGE
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
76101139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.90 |
| 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 |
$682.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$742.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.57
|
| Rate for Payer: PHCS Commercial |
$818.88
|
| Rate for Payer: United Healthcare All Payer |
$750.64
|
|
|
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 |
$511.80 |
| Rate for Payer: Aetna Commercial |
$122.78
|
| Rate for Payer: Ambetter Exchange |
$73.86
|
| 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 Individual/Medicaid |
$73.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.63
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$73.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.86
|
| 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 |
$96.02
|
| Rate for Payer: UHCCP Medicaid |
$62.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.86
|
|
|
CONTROL NASAL HEMORRHAGE
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
76101139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| 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 |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$665.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| 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 |
$119.10
|
| 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 |
$142.92
|
| 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 |
$682.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$742.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.57
|
| 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 |
$250.19 |
| Rate for Payer: Aetna Commercial |
$122.78
|
| Rate for Payer: Ambetter Exchange |
$73.86
|
| 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 Individual/Medicaid |
$73.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.63
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$73.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.86
|
| 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 |
$96.02
|
| Rate for Payer: UHCCP Medicaid |
$62.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.86
|
|
|
CONTROL NASAL HEMORRHAGE(T
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
761T1139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| 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 |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| 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 |
$119.10
|
| 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 |
$142.92
|
| 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 |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.57
|
| 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 |
$135.90 |
| 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 |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.57
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
