|
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 |
$366.14 |
| 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 |
$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: 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 |
$240.00
|
| 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 HEMORR(T
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
761T1141
|
|
Hospital Revenue Code
|
761
|
| 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(T
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
761T1141
|
|
Hospital Revenue Code
|
761
|
| 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 NASL HEM POSTERI INITI
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
761T1140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.60 |
| 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 |
$369.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.78
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
CONTROL NASL HEM POSTERI INITI
|
Facility
|
IP
|
$912.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
76101140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.60 |
| 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 |
$729.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$793.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.28
|
| Rate for Payer: PHCS Commercial |
$875.52
|
| Rate for Payer: United Healthcare All Payer |
$802.56
|
|
|
CONTROL NASL HEM POSTERI INITI
|
Facility
|
OP
|
$912.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
76101140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| 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 |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$711.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| 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 |
$119.10
|
| 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 |
$142.92
|
| 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 |
$729.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$793.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.28
|
| 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 |
45000210
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.10 |
| 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 |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| 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 |
$119.10
|
| 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 |
$142.92
|
| 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 |
$369.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.78
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
CONTROL NASL HEM POSTERI INITI
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
761T1140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| 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 |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| 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 |
$119.10
|
| 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 |
$142.92
|
| 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 |
$369.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.78
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
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 |
$547.20 |
| Rate for Payer: Aetna Commercial |
$157.95
|
| Rate for Payer: Ambetter Exchange |
$101.09
|
| 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 Individual/Medicaid |
$101.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.31
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$101.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.09
|
| 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 |
$131.42
|
| Rate for Payer: UHCCP Medicaid |
$78.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.09
|
|
|
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 |
$277.18 |
| Rate for Payer: Aetna Commercial |
$157.95
|
| Rate for Payer: Ambetter Exchange |
$101.09
|
| 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 Individual/Medicaid |
$101.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.31
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$101.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.09
|
| 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 |
$131.42
|
| Rate for Payer: UHCCP Medicaid |
$78.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.09
|
|
|
CONTROL NASL HEM POSTERI INITI
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
45000210
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.60 |
| 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 |
$369.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.78
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
CONTROL OF NASOPHARY HEMORR
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
76102561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.00 |
| 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 |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| 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 |
$1,548.24 |
| 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 |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,251.00
|
| 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 |
$2,996.53
|
| 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 |
$3,595.84
|
| 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 |
$3,601.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,916.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,106.38
|
| Rate for Payer: PHCS Commercial |
$4,321.92
|
| Rate for Payer: United Healthcare All Payer |
$3,961.76
|
|
|
CONTROL OF NASOPHARY HEMORR
|
Facility
|
OP
|
$417.00
|
|
| Hospital Charge Code |
45000333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.10 |
| 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 |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
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 |
$2,701.20 |
| Rate for Payer: Aetna Commercial |
$751.81
|
| Rate for Payer: Ambetter Exchange |
$478.85
|
| Rate for Payer: Anthem Medicaid |
$331.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$478.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$478.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$574.62
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$478.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.85
|
| 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 |
$622.50
|
| Rate for Payer: UHCCP Medicaid |
$1,575.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$478.85
|
|
|
CONTROL OF NASOPHARY HEMORR
|
Facility
|
IP
|
$417.00
|
|
| Hospital Charge Code |
45000333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.10 |
| 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 |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
CONTROL OF NASOPHARY HEMORR
|
Facility
|
IP
|
$4,502.00
|
|
|
Service Code
|
HCPCS 42972
|
| Hospital Charge Code |
76101717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,350.60 |
| 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 |
$3,601.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,916.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,106.38
|
| 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 |
$120.00 |
| 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 |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
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: Ambetter Exchange |
$478.85
|
| Rate for Payer: Anthem Medicaid |
$331.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$478.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$478.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$574.62
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$478.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.85
|
| 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 |
$622.50
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$478.85
|
|
|
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 |
$1,125.60 |
| 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 |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| 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 |
$1,290.31 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$1,876.00
|
| 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 |
$2,996.53
|
| 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 |
$3,595.84
|
| 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 |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| 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
|
$4,195.14
|
|
|
Service Code
|
CPT 42962
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,996.53 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
|
|
CONTROL OROPH HEMORR COMPLICAT
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS 42961
|
| Hospital Charge Code |
76101715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.50 |
| 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 |
$199.75
|
| 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: 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 |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.75
|
| 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: Ambetter Exchange |
$395.01
|
| Rate for Payer: Anthem Medicaid |
$203.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$395.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$395.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$474.01
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$395.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.01
|
| 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 |
$513.51
|
| Rate for Payer: UHCCP Medicaid |
$201.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$395.01
|
|
|
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: Ambetter Exchange |
$395.01
|
| Rate for Payer: Anthem Medicaid |
$203.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$395.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$395.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$474.01
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$395.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.01
|
| 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 |
$513.51
|
| Rate for Payer: UHCCP Medicaid |
$201.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$395.01
|
|
