|
NAROPIN 1MG (150MG/30ML) VIAL
|
Facility
|
OP
|
$115.50
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Anthem Medicaid |
$39.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.09
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
| Rate for Payer: Humana Commercial |
$98.18
|
| Rate for Payer: Humana KY Medicaid |
$39.72
|
| Rate for Payer: Kentucky WC Medicaid |
$40.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.64
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.80
|
| Rate for Payer: PHCS Commercial |
$110.88
|
| Rate for Payer: United Healthcare All Payer |
$101.64
|
|
|
NAROPIN 1MG (150MG/30ML) VIAL
|
Facility
|
IP
|
$115.50
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.09
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
| Rate for Payer: Humana Commercial |
$98.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.64
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.80
|
| Rate for Payer: PHCS Commercial |
$110.88
|
| Rate for Payer: United Healthcare All Payer |
$101.64
|
|
|
NAROPIN 1 MG (200MG VIAL)
|
Facility
|
OP
|
$194.63
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002352
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$186.84 |
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Anthem Medicaid |
$66.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.81
|
| Rate for Payer: Cash Price |
$97.32
|
| Rate for Payer: Cigna Commercial |
$161.54
|
| Rate for Payer: First Health Commercial |
$184.90
|
| Rate for Payer: Humana Commercial |
$165.44
|
| Rate for Payer: Humana KY Medicaid |
$66.93
|
| Rate for Payer: Kentucky WC Medicaid |
$67.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.27
|
| Rate for Payer: Ohio Health Group HMO |
$145.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.34
|
| Rate for Payer: PHCS Commercial |
$186.84
|
| Rate for Payer: United Healthcare All Payer |
$171.27
|
|
|
NAROPIN 1 MG (200MG VIAL)
|
Facility
|
IP
|
$194.63
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002352
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$186.84 |
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.81
|
| Rate for Payer: Cash Price |
$97.32
|
| Rate for Payer: Cigna Commercial |
$161.54
|
| Rate for Payer: First Health Commercial |
$184.90
|
| Rate for Payer: Humana Commercial |
$165.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.27
|
| Rate for Payer: Ohio Health Group HMO |
$145.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.34
|
| Rate for Payer: PHCS Commercial |
$186.84
|
| Rate for Payer: United Healthcare All Payer |
$171.27
|
|
|
NAROPIN (ROPIVACAINE)7.5MG/ML
|
Facility
|
IP
|
$125.90
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002351
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$120.86 |
| Rate for Payer: Aetna Commercial |
$96.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.20
|
| Rate for Payer: Cash Price |
$62.95
|
| Rate for Payer: Cigna Commercial |
$104.50
|
| Rate for Payer: First Health Commercial |
$119.60
|
| Rate for Payer: Humana Commercial |
$107.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.79
|
| Rate for Payer: Ohio Health Group HMO |
$94.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.03
|
| Rate for Payer: PHCS Commercial |
$120.86
|
| Rate for Payer: United Healthcare All Payer |
$110.79
|
|
|
NAROPIN (ROPIVACAINE)7.5MG/ML
|
Facility
|
OP
|
$125.90
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002351
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$120.86 |
| Rate for Payer: Aetna Commercial |
$96.94
|
| Rate for Payer: Anthem Medicaid |
$43.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.20
|
| Rate for Payer: Cash Price |
$62.95
|
| Rate for Payer: Cigna Commercial |
$104.50
|
| Rate for Payer: First Health Commercial |
$119.60
|
| Rate for Payer: Humana Commercial |
$107.02
|
| Rate for Payer: Humana KY Medicaid |
$43.30
|
| Rate for Payer: Kentucky WC Medicaid |
$43.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.79
|
| Rate for Payer: Ohio Health Group HMO |
$94.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.03
|
| Rate for Payer: PHCS Commercial |
$120.86
|
| Rate for Payer: United Healthcare All Payer |
$110.79
|
|
|
NASAL BALLOON TAMPONADE
|
Facility
|
IP
|
$5,229.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
76101149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$679.85 |
| Max. Negotiated Rate |
$5,020.44 |
| Rate for Payer: Aetna Commercial |
$4,026.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,079.11
|
| Rate for Payer: Cash Price |
$2,614.82
|
| Rate for Payer: Cigna Commercial |
$4,340.59
|
| Rate for Payer: First Health Commercial |
$4,968.15
|
| Rate for Payer: Humana Commercial |
$4,445.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,288.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,859.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,568.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,602.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,922.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,045.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.19
|
| Rate for Payer: PHCS Commercial |
$5,020.44
|
| Rate for Payer: United Healthcare All Payer |
$4,602.07
|
|
|
NASAL BALLOON TAMPONADE
|
Facility
|
OP
|
$5,229.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
76101149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$679.85 |
| Max. Negotiated Rate |
$5,020.44 |
| Rate for Payer: Aetna Commercial |
$4,026.82
|
| Rate for Payer: Anthem Medicaid |
$1,798.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,079.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$2,614.82
|
| Rate for Payer: Cash Price |
$2,614.82
|
| Rate for Payer: Cigna Commercial |
$4,340.59
|
| Rate for Payer: First Health Commercial |
$4,968.15
|
| Rate for Payer: Humana Commercial |
$4,445.19
|
| Rate for Payer: Humana KY Medicaid |
$1,798.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,816.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,288.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,859.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,834.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,602.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,922.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,045.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.19
|
| Rate for Payer: PHCS Commercial |
$5,020.44
|
| Rate for Payer: United Healthcare All Payer |
$4,602.07
|
|
|
NASAL BALLOON TAMPONADE
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
45000212
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.68 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.16
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
NASAL BALLOON TAMPONADE
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
45000212
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.68 |
| Max. Negotiated Rate |
$2,054.81 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.16
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
NASAL BALLOON TAMPONADE
|
Professional
|
Both
|
$5,229.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
76101149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.84 |
| Max. Negotiated Rate |
$5,229.63 |
| Rate for Payer: Aetna Commercial |
$297.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.84
|
| Rate for Payer: Anthem Medicaid |
$162.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,229.63
|
| Rate for Payer: Cash Price |
$2,614.82
|
| Rate for Payer: Cash Price |
$2,614.82
|
| Rate for Payer: Cigna Commercial |
$478.36
|
| Rate for Payer: Healthspan PPO |
$397.44
|
| Rate for Payer: Humana Medicaid |
$162.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$256.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.77
|
| Rate for Payer: Molina Healthcare Passport |
$162.52
|
| Rate for Payer: Multiplan PHCS |
$3,137.78
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,660.74
|
| Rate for Payer: UHCCP Medicaid |
$99.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.15
|
|
|
NASAL BALLOON TAMPONADE(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
761P1149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.84 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$297.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.84
|
| Rate for Payer: Anthem Medicaid |
$162.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$478.36
|
| Rate for Payer: Healthspan PPO |
$397.44
|
| Rate for Payer: Humana Medicaid |
$162.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$256.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.77
|
| Rate for Payer: Molina Healthcare Passport |
$162.52
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$99.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.15
|
|
|
NASAL BALLOON TAMPONADE(T
|
Facility
|
IP
|
$4,379.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
761T1149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$569.35 |
| Max. Negotiated Rate |
$4,204.44 |
| Rate for Payer: Aetna Commercial |
$3,372.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,416.11
|
| Rate for Payer: Cash Price |
$2,189.82
|
| Rate for Payer: Cigna Commercial |
$3,635.09
|
| Rate for Payer: First Health Commercial |
$4,160.65
|
| Rate for Payer: Humana Commercial |
$3,722.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,591.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,232.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,313.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,854.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,284.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$875.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.69
|
| Rate for Payer: PHCS Commercial |
$4,204.44
|
| Rate for Payer: United Healthcare All Payer |
$3,854.07
|
|
|
NASAL BALLOON TAMPONADE(T
|
Facility
|
OP
|
$4,379.63
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
761T1149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$569.35 |
| Max. Negotiated Rate |
$4,204.44 |
| Rate for Payer: Aetna Commercial |
$3,372.32
|
| Rate for Payer: Anthem Medicaid |
$1,506.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,416.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$2,189.82
|
| Rate for Payer: Cash Price |
$2,189.82
|
| Rate for Payer: Cigna Commercial |
$3,635.09
|
| Rate for Payer: First Health Commercial |
$4,160.65
|
| Rate for Payer: Humana Commercial |
$3,722.69
|
| Rate for Payer: Humana KY Medicaid |
$1,506.15
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,521.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,591.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,232.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,536.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,854.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,284.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$875.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.69
|
| Rate for Payer: PHCS Commercial |
$4,204.44
|
| Rate for Payer: United Healthcare All Payer |
$3,854.07
|
|
|
NASAL BONES 3V
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$433.92 |
| Rate for Payer: Aetna Commercial |
$348.04
|
| Rate for Payer: Anthem Medicaid |
$155.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cigna Commercial |
$375.16
|
| Rate for Payer: First Health Commercial |
$429.40
|
| Rate for Payer: Humana Commercial |
$384.20
|
| Rate for Payer: Humana KY Medicaid |
$155.44
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$157.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$370.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$333.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$397.76
|
| Rate for Payer: Ohio Health Group HMO |
$339.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.12
|
| Rate for Payer: PHCS Commercial |
$433.92
|
| Rate for Payer: United Healthcare All Payer |
$397.76
|
|
|
NASAL BONES 3V
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$433.92 |
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Aetna Commercial |
$348.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.56
|
| Rate for Payer: Cigna Commercial |
$375.16
|
| Rate for Payer: First Health Commercial |
$429.40
|
| Rate for Payer: Humana Commercial |
$384.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$370.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$333.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$397.76
|
| Rate for Payer: Ohio Health Group HMO |
$339.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.12
|
| Rate for Payer: PHCS Commercial |
$433.92
|
| Rate for Payer: United Healthcare All Payer |
$397.76
|
|
|
NASAL BONES 3V
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Anthem Medicaid |
$21.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$452.00
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cigna Commercial |
$43.65
|
| Rate for Payer: Healthspan PPO |
$44.79
|
| Rate for Payer: Humana Medicaid |
$21.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare Passport |
$21.52
|
| Rate for Payer: Multiplan PHCS |
$271.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$316.40
|
| Rate for Payer: UHCCP Medicaid |
$158.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.74
|
|
|
NASAL BONES 3V(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
320P0013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Anthem Medicaid |
$21.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$43.65
|
| Rate for Payer: Healthspan PPO |
$44.79
|
| Rate for Payer: Humana Medicaid |
$21.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare Passport |
$21.52
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.74
|
|
|
NASAL BONES 3V(T
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
320T0013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
NASAL BONES 3V(T
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
320T0013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
NASALCROM(CROMOLYN) SPRAY
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 14832001101
|
| Hospital Charge Code |
25001052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.06
|
| Rate for Payer: First Health Commercial |
$0.07
|
| Rate for Payer: Humana Commercial |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.06
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
|
NASALCROM(CROMOLYN) SPRAY
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 14832001101
|
| Hospital Charge Code |
25001052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem Medicaid |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.06
|
| Rate for Payer: First Health Commercial |
$0.07
|
| Rate for Payer: Humana Commercial |
$0.06
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.06
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
|
NASAL ENDOSCOPY
|
Facility
|
OP
|
$1,802.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
76101147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.29 |
| Max. Negotiated Rate |
$1,729.92 |
| Rate for Payer: Aetna Commercial |
$1,387.54
|
| Rate for Payer: Anthem Medicaid |
$619.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$171.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$239.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$231.24
|
| Rate for Payer: Cash Price |
$901.00
|
| Rate for Payer: Cash Price |
$901.00
|
| Rate for Payer: Cigna Commercial |
$1,495.66
|
| Rate for Payer: First Health Commercial |
$1,711.90
|
| Rate for Payer: Humana Commercial |
$1,531.70
|
| Rate for Payer: Humana KY Medicaid |
$619.71
|
| Rate for Payer: Humana Medicare Advantage |
$171.29
|
| Rate for Payer: Kentucky WC Medicaid |
$626.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.62
|
| Rate for Payer: PHCS Commercial |
$1,729.92
|
| Rate for Payer: United Healthcare All Payer |
$1,585.76
|
|
|
NASAL ENDOSCOPY
|
Facility
|
IP
|
$1,802.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
76101147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.26 |
| Max. Negotiated Rate |
$1,729.92 |
| Rate for Payer: Aetna Commercial |
$1,387.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.56
|
| Rate for Payer: Cash Price |
$901.00
|
| Rate for Payer: Cigna Commercial |
$1,495.66
|
| Rate for Payer: First Health Commercial |
$1,711.90
|
| Rate for Payer: Humana Commercial |
$1,531.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.62
|
| Rate for Payer: PHCS Commercial |
$1,729.92
|
| Rate for Payer: United Healthcare All Payer |
$1,585.76
|
|
|
NASAL ENDOSCOPY
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
76101147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.36 |
| Max. Negotiated Rate |
$1,802.00 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.36
|
| Rate for Payer: Anthem Medicaid |
$72.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,802.00
|
| Rate for Payer: Cash Price |
$901.00
|
| Rate for Payer: Cash Price |
$901.00
|
| Rate for Payer: Cigna Commercial |
$255.87
|
| Rate for Payer: Healthspan PPO |
$216.93
|
| Rate for Payer: Humana Medicaid |
$72.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$98.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.12
|
| Rate for Payer: Molina Healthcare Passport |
$72.67
|
| Rate for Payer: Multiplan PHCS |
$1,081.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,261.40
|
| Rate for Payer: UHCCP Medicaid |
$33.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.40
|
|
