|
LYSE CHEST FIBRIN SUBQ DAY(P
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 32562
|
| Hospital Charge Code |
761P1206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$111.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.28
|
| Rate for Payer: Anthem Medicaid |
$48.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.00
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$144.56
|
| Rate for Payer: Healthspan PPO |
$87.43
|
| Rate for Payer: Humana Medicaid |
$48.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.67
|
| Rate for Payer: Molina Healthcare Passport |
$48.70
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.50
|
| Rate for Payer: UHCCP Medicaid |
$31.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.19
|
|
|
LYSE CHEST FIBRIN SUBQ DAY(T
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
HCPCS 32562
|
| Hospital Charge Code |
761T1206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.05 |
| Max. Negotiated Rate |
$1,041.60 |
| Rate for Payer: Aetna Commercial |
$835.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$846.30
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$900.55
|
| Rate for Payer: First Health Commercial |
$1,030.75
|
| Rate for Payer: Humana Commercial |
$922.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$889.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$800.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$954.80
|
| Rate for Payer: Ohio Health Group HMO |
$813.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.35
|
| Rate for Payer: PHCS Commercial |
$1,041.60
|
| Rate for Payer: United Healthcare All Payer |
$954.80
|
|
|
LYSE CHEST FIBRIN SUBQ DAY(T
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
HCPCS 32562
|
| Hospital Charge Code |
761T1206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.05 |
| Max. Negotiated Rate |
$1,041.60 |
| Rate for Payer: Aetna Commercial |
$835.45
|
| Rate for Payer: Anthem Medicaid |
$373.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$846.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$900.55
|
| Rate for Payer: First Health Commercial |
$1,030.75
|
| Rate for Payer: Humana Commercial |
$922.25
|
| Rate for Payer: Humana KY Medicaid |
$373.13
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$376.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$889.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$800.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$380.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$954.80
|
| Rate for Payer: Ohio Health Group HMO |
$813.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.35
|
| Rate for Payer: PHCS Commercial |
$1,041.60
|
| Rate for Payer: United Healthcare All Payer |
$954.80
|
|
|
LYSIS INTRANASAL SYNECHIA
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 30560
|
| Hospital Charge Code |
76101134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$494.40 |
| Rate for Payer: Aetna Commercial |
$396.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.70
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$427.45
|
| Rate for Payer: First Health Commercial |
$489.25
|
| Rate for Payer: Humana Commercial |
$437.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.20
|
| Rate for Payer: Ohio Health Group HMO |
$386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.65
|
| Rate for Payer: PHCS Commercial |
$494.40
|
| Rate for Payer: United Healthcare All Payer |
$453.20
|
|
|
LYSIS INTRANASAL SYNECHIA
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 30560
|
| Hospital Charge Code |
76101134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$396.55
|
| Rate for Payer: Anthem Medicaid |
$177.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$427.45
|
| Rate for Payer: First Health Commercial |
$489.25
|
| Rate for Payer: Humana Commercial |
$437.75
|
| Rate for Payer: Humana KY Medicaid |
$177.11
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$178.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.20
|
| Rate for Payer: Ohio Health Group HMO |
$386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.65
|
| Rate for Payer: PHCS Commercial |
$494.40
|
| Rate for Payer: United Healthcare All Payer |
$453.20
|
|
|
LYSIS INTRANASAL SYNECHIA
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 30560
|
| Hospital Charge Code |
76101134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$78.21
|
| Rate for Payer: Anthem Medicaid |
$44.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$515.00
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$347.64
|
| Rate for Payer: Healthspan PPO |
$298.51
|
| Rate for Payer: Humana Medicaid |
$44.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.23
|
| Rate for Payer: Molina Healthcare Passport |
$44.34
|
| Rate for Payer: Multiplan PHCS |
$309.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$360.50
|
| Rate for Payer: UHCCP Medicaid |
$82.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.78
|
|
|
LYSIS INTRANASAL SYNECHIA(P
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 30560
|
| Hospital Charge Code |
761P1134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$78.21
|
| Rate for Payer: Anthem Medicaid |
$44.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$515.00
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$347.64
|
| Rate for Payer: Healthspan PPO |
$298.51
|
| Rate for Payer: Humana Medicaid |
$44.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.23
|
| Rate for Payer: Molina Healthcare Passport |
$44.34
|
| Rate for Payer: Multiplan PHCS |
$309.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$360.50
|
| Rate for Payer: UHCCP Medicaid |
$82.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.78
|
|
|
LYSIS OF ADHESIONS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58740
|
| Hospital Charge Code |
76102257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
LYSIS OF ADHESIONS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58740
|
| Hospital Charge Code |
76102257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
LYSIS OF ADHESIONS
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58740
|
| Hospital Charge Code |
76102257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.93 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,325.75
|
| Rate for Payer: Anthem Medicaid |
$381.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,294.46
|
| Rate for Payer: Healthspan PPO |
$1,283.66
|
| Rate for Payer: Humana Medicaid |
$381.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,139.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.57
|
| Rate for Payer: Molina Healthcare Passport |
$381.93
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$385.75
|
|
|
LYSIS OF ADHESIONS(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 58740
|
| Hospital Charge Code |
761P2257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.93 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,325.75
|
| Rate for Payer: Anthem Medicaid |
$381.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,294.46
|
| Rate for Payer: Healthspan PPO |
$1,283.66
|
| Rate for Payer: Humana Medicaid |
$381.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,139.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.57
|
| Rate for Payer: Molina Healthcare Passport |
$381.93
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$385.75
|
|
|
LYSIS OF LABIAL ADHESIONS
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 56441
|
| Hospital Charge Code |
76102157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.92 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$211.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$102.92
|
| Rate for Payer: Anthem Medicaid |
$107.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$335.00
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$202.11
|
| Rate for Payer: Healthspan PPO |
$215.71
|
| Rate for Payer: Humana Medicaid |
$107.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$179.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.05
|
| Rate for Payer: Molina Healthcare Passport |
$107.89
|
| Rate for Payer: Multiplan PHCS |
$201.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$234.50
|
| Rate for Payer: UHCCP Medicaid |
$108.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.97
|
|
|
LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 56441
|
| Hospital Charge Code |
76102157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 56441
|
| Hospital Charge Code |
76102157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
LYSIS OF LABIAL ADHESIONS(P
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 56441
|
| Hospital Charge Code |
761P2157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.92 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$211.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$102.92
|
| Rate for Payer: Anthem Medicaid |
$107.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$335.00
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$202.11
|
| Rate for Payer: Healthspan PPO |
$215.71
|
| Rate for Payer: Humana Medicaid |
$107.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$179.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.05
|
| Rate for Payer: Molina Healthcare Passport |
$107.89
|
| Rate for Payer: Multiplan PHCS |
$201.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$234.50
|
| Rate for Payer: UHCCP Medicaid |
$108.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.97
|
|
|
LYSIS OF PENILE ADHESIONS
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 55899
|
| Hospital Charge Code |
76102846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
|
|
LYSIS OF PENILE ADHESIONS
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 55899
|
| Hospital Charge Code |
76102846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$299.21 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem Medicaid |
$94.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Humana KY Medicaid |
$94.57
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$95.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.25
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
LYSIS OF PENILE ADHESIONS
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 55899
|
| Hospital Charge Code |
76102846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.25
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
LYSIS PERINEAL ADHES;SEP PROC
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
76101802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$1,580.74
|
| Rate for Payer: Anthem Medicaid |
$631.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,466.69
|
| Rate for Payer: Healthspan PPO |
$1,333.07
|
| Rate for Payer: Humana Medicaid |
$631.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,396.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.63
|
| Rate for Payer: Molina Healthcare Passport |
$631.99
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$638.31
|
|
|
LYSIS PERINEAL ADHES;SEP PROC
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
76101802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
LYSIS PERINEAL ADHES;SEP PROC
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
76101802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
LYSIS PERINEAL ADHES;SEP PRO(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
761P1802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$1,580.74
|
| Rate for Payer: Anthem Medicaid |
$631.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,466.69
|
| Rate for Payer: Healthspan PPO |
$1,333.07
|
| Rate for Payer: Humana Medicaid |
$631.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,396.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.63
|
| Rate for Payer: Molina Healthcare Passport |
$631.99
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$638.31
|
|
|
M2A MAGNUM MOD HD SZ 46MM
|
Facility
|
OP
|
$8,442.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$8,105.18 |
| Rate for Payer: Aetna Commercial |
$6,501.03
|
| Rate for Payer: Anthem Medicaid |
$2,903.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,585.46
|
| Rate for Payer: Cash Price |
$4,221.45
|
| Rate for Payer: Cigna Commercial |
$7,007.61
|
| Rate for Payer: First Health Commercial |
$8,020.76
|
| Rate for Payer: Humana Commercial |
$7,176.46
|
| Rate for Payer: Humana KY Medicaid |
$2,903.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,933.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,923.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,230.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,532.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,961.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,429.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,332.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,097.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,617.30
|
| Rate for Payer: PHCS Commercial |
$8,105.18
|
| Rate for Payer: United Healthcare All Payer |
$7,429.75
|
|
|
M2A MAGNUM MOD HD SZ 46MM
|
Facility
|
IP
|
$8,442.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$8,105.18 |
| Rate for Payer: Aetna Commercial |
$6,501.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,585.46
|
| Rate for Payer: Cash Price |
$4,221.45
|
| Rate for Payer: Cigna Commercial |
$7,007.61
|
| Rate for Payer: First Health Commercial |
$8,020.76
|
| Rate for Payer: Humana Commercial |
$7,176.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,923.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,230.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,532.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,429.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,332.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,097.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,617.30
|
| Rate for Payer: PHCS Commercial |
$8,105.18
|
| Rate for Payer: United Healthcare All Payer |
$7,429.75
|
|
|
M2A MAGNUM PF CUP 520DX461D
|
Facility
|
IP
|
$19,684.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.01 |
| Max. Negotiated Rate |
$18,897.31 |
| Rate for Payer: Aetna Commercial |
$15,157.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,354.07
|
| Rate for Payer: Cash Price |
$9,842.35
|
| Rate for Payer: Cigna Commercial |
$16,338.30
|
| Rate for Payer: First Health Commercial |
$18,700.46
|
| Rate for Payer: Humana Commercial |
$16,732.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,141.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,527.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,905.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,322.54
|
| Rate for Payer: Ohio Health Group HMO |
$14,763.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,936.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,559.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,102.26
|
| Rate for Payer: PHCS Commercial |
$18,897.31
|
| Rate for Payer: United Healthcare All Payer |
$17,322.54
|
|
