|
SINGULAIR 4 MG CHEW TAB
|
Facility
|
IP
|
$4.56
|
|
|
Service Code
|
NDC 31722072730
|
| Hospital Charge Code |
25001405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cigna Commercial |
$3.78
|
| Rate for Payer: First Health Commercial |
$4.33
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.01
|
| Rate for Payer: Ohio Health Group HMO |
$3.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Payer |
$4.01
|
|
|
SINGULAIR 4 MG CHEW TAB
|
Facility
|
OP
|
$4.56
|
|
|
Service Code
|
NDC 31722072730
|
| Hospital Charge Code |
25001405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Anthem Medicaid |
$1.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cigna Commercial |
$3.78
|
| Rate for Payer: First Health Commercial |
$4.33
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Humana KY Medicaid |
$1.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.01
|
| Rate for Payer: Ohio Health Group HMO |
$3.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Payer |
$4.01
|
|
|
SINGULAIR 4MG GRANULES
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 27241001531
|
| Hospital Charge Code |
25001406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Anthem Medicaid |
$3.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.58
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$9.13
|
| Rate for Payer: First Health Commercial |
$10.45
|
| Rate for Payer: Humana Commercial |
$9.35
|
| Rate for Payer: Humana KY Medicaid |
$3.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.68
|
| Rate for Payer: Ohio Health Group HMO |
$8.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.59
|
| Rate for Payer: PHCS Commercial |
$10.56
|
| Rate for Payer: United Healthcare All Payer |
$9.68
|
|
|
SINGULAIR 4MG GRANULES
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 27241001531
|
| Hospital Charge Code |
25001406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.58
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$9.13
|
| Rate for Payer: First Health Commercial |
$10.45
|
| Rate for Payer: Humana Commercial |
$9.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.68
|
| Rate for Payer: Ohio Health Group HMO |
$8.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.59
|
| Rate for Payer: PHCS Commercial |
$10.56
|
| Rate for Payer: United Healthcare All Payer |
$9.68
|
|
|
SINGULAR (MONTELUKAST)10MG TAB
|
Facility
|
OP
|
$4.53
|
|
|
Service Code
|
NDC 904680861
|
| Hospital Charge Code |
25001408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.76
|
| Rate for Payer: First Health Commercial |
$4.30
|
| Rate for Payer: Humana Commercial |
$3.85
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.99
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| Rate for Payer: PHCS Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Payer |
$3.99
|
|
|
SINGULAR (MONTELUKAST)10MG TAB
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
NDC 904680861
|
| Hospital Charge Code |
25001408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.76
|
| Rate for Payer: First Health Commercial |
$4.30
|
| Rate for Payer: Humana Commercial |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.99
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| Rate for Payer: PHCS Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Payer |
$3.99
|
|
|
SINGULAR (MONTELUKAST) 5MG TAB
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 57237021390
|
| Hospital Charge Code |
25001407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
SINGULAR (MONTELUKAST) 5MG TAB
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 57237021390
|
| Hospital Charge Code |
25001407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
SINUS ENDO
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 31256
|
| Hospital Charge Code |
76101155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.58 |
| Max. Negotiated Rate |
$4,769.34 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem Medicaid |
$333.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,406.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,769.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,599.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Humana KY Medicaid |
$333.58
|
| Rate for Payer: Humana Medicare Advantage |
$3,406.67
|
| Rate for Payer: Kentucky WC Medicaid |
$336.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,088.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$340.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
SINUS ENDO
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 31256
|
| Hospital Charge Code |
76101155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Aetna Commercial |
$304.41
|
| Rate for Payer: Ambetter Exchange |
$170.86
|
| Rate for Payer: Anthem Medicaid |
$207.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$170.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$170.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$205.03
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$307.15
|
| Rate for Payer: Healthspan PPO |
$256.72
|
| Rate for Payer: Humana Medicaid |
$207.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$170.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.77
|
| Rate for Payer: Molina Healthcare Passport |
$207.62
|
| Rate for Payer: Multiplan PHCS |
$582.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$222.12
|
| Rate for Payer: UHCCP Medicaid |
$339.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$170.86
|
|
|
SINUS ENDO
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 31256
|
| Hospital Charge Code |
76101155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
SINUS ENDO(P
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 31256
|
| Hospital Charge Code |
761P1155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Aetna Commercial |
$304.41
|
| Rate for Payer: Ambetter Exchange |
$170.86
|
| Rate for Payer: Anthem Medicaid |
$207.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$170.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$170.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$205.03
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$307.15
|
| Rate for Payer: Healthspan PPO |
$256.72
|
| Rate for Payer: Humana Medicaid |
$207.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$170.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.77
|
| Rate for Payer: Molina Healthcare Passport |
$207.62
|
| Rate for Payer: Multiplan PHCS |
$582.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$222.12
|
| Rate for Payer: UHCCP Medicaid |
$339.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$170.86
|
|
|
SINUS ENDO W/BALLOON DIL
|
Facility
|
IP
|
$2,845.00
|
|
|
Service Code
|
HCPCS 31295
|
| Hospital Charge Code |
76101159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$853.50 |
| Max. Negotiated Rate |
$2,731.20 |
| Rate for Payer: Aetna Commercial |
$2,190.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,219.10
|
| Rate for Payer: Cash Price |
$1,422.50
|
| Rate for Payer: Cigna Commercial |
$2,361.35
|
| Rate for Payer: First Health Commercial |
$2,702.75
|
| Rate for Payer: Humana Commercial |
$2,418.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,332.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,099.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$853.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,503.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,133.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,475.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,963.05
|
| Rate for Payer: PHCS Commercial |
$2,731.20
|
| Rate for Payer: United Healthcare All Payer |
$2,503.60
|
|
|
SINUS ENDO W/BALLOON DIL
|
Professional
|
Both
|
$2,845.00
|
|
|
Service Code
|
HCPCS 31295
|
| Hospital Charge Code |
76101159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.42 |
| Max. Negotiated Rate |
$3,087.02 |
| Rate for Payer: Aetna Commercial |
$280.56
|
| Rate for Payer: Ambetter Exchange |
$148.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$84.42
|
| Rate for Payer: Anthem Medicaid |
$1,397.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$148.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$148.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$178.79
|
| Rate for Payer: Cash Price |
$1,422.50
|
| Rate for Payer: Cash Price |
$1,422.50
|
| Rate for Payer: Cigna Commercial |
$3,087.02
|
| Rate for Payer: Healthspan PPO |
$1,997.11
|
| Rate for Payer: Humana Medicaid |
$1,397.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$148.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,425.16
|
| Rate for Payer: Molina Healthcare Passport |
$1,397.22
|
| Rate for Payer: Multiplan PHCS |
$1,707.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$193.69
|
| Rate for Payer: UHCCP Medicaid |
$88.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,411.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$148.99
|
|
|
SINUS ENDO W/BALLOON DIL
|
Facility
|
OP
|
$2,845.00
|
|
|
Service Code
|
HCPCS 31295
|
| Hospital Charge Code |
76101159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$978.40 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$2,190.65
|
| Rate for Payer: Anthem Medicaid |
$978.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,219.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,954.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,634.90
|
| Rate for Payer: Cash Price |
$1,422.50
|
| Rate for Payer: Cash Price |
$1,422.50
|
| Rate for Payer: Cigna Commercial |
$2,361.35
|
| Rate for Payer: First Health Commercial |
$2,702.75
|
| Rate for Payer: Humana Commercial |
$2,418.25
|
| Rate for Payer: Humana KY Medicaid |
$978.40
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Kentucky WC Medicaid |
$988.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,332.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,099.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$998.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,503.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,133.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,475.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,963.05
|
| Rate for Payer: PHCS Commercial |
$2,731.20
|
| Rate for Payer: United Healthcare All Payer |
$2,503.60
|
|
|
SINUS ENDO W/BALLOON DIL(P
|
Professional
|
Both
|
$2,845.00
|
|
|
Service Code
|
HCPCS 31295
|
| Hospital Charge Code |
761P1159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.42 |
| Max. Negotiated Rate |
$3,087.02 |
| Rate for Payer: Aetna Commercial |
$280.56
|
| Rate for Payer: Ambetter Exchange |
$148.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$84.42
|
| Rate for Payer: Anthem Medicaid |
$1,397.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$148.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$148.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$178.79
|
| Rate for Payer: Cash Price |
$1,422.50
|
| Rate for Payer: Cash Price |
$1,422.50
|
| Rate for Payer: Cigna Commercial |
$3,087.02
|
| Rate for Payer: Healthspan PPO |
$1,997.11
|
| Rate for Payer: Humana Medicaid |
$1,397.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$148.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,425.16
|
| Rate for Payer: Molina Healthcare Passport |
$1,397.22
|
| Rate for Payer: Multiplan PHCS |
$1,707.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$193.69
|
| Rate for Payer: UHCCP Medicaid |
$88.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,411.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$148.99
|
|
|
SINUSOTOMY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 31030
|
| Hospital Charge Code |
76101145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.57 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$737.85
|
| Rate for Payer: Ambetter Exchange |
$478.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$264.57
|
| Rate for Payer: Anthem Medicaid |
$377.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$478.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$478.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$574.34
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$727.34
|
| Rate for Payer: Healthspan PPO |
$808.65
|
| Rate for Payer: Humana Medicaid |
$377.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$655.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$478.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$384.82
|
| Rate for Payer: Molina Healthcare Passport |
$377.27
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$622.21
|
| Rate for Payer: UHCCP Medicaid |
$277.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$478.62
|
|
|
SINUSOTOMY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 31030
|
| Hospital Charge Code |
76101145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
SINUSOTOMY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 31030
|
| Hospital Charge Code |
76101145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
SINUSOTOMY(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 31030
|
| Hospital Charge Code |
761P1145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.57 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$737.85
|
| Rate for Payer: Ambetter Exchange |
$478.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$264.57
|
| Rate for Payer: Anthem Medicaid |
$377.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$478.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$478.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$574.34
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$727.34
|
| Rate for Payer: Healthspan PPO |
$808.65
|
| Rate for Payer: Humana Medicaid |
$377.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$655.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$478.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$384.82
|
| Rate for Payer: Molina Healthcare Passport |
$377.27
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$622.21
|
| Rate for Payer: UHCCP Medicaid |
$277.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$478.62
|
|
|
SION BLUE PTCA GW 180CM
|
Facility
|
IP
|
$1,519.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$1,458.43 |
| Rate for Payer: Aetna Commercial |
$1,169.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.98
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,260.94
|
| Rate for Payer: First Health Commercial |
$1,443.24
|
| Rate for Payer: Humana Commercial |
$1,291.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,336.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,215.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,321.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.25
|
| Rate for Payer: PHCS Commercial |
$1,458.43
|
| Rate for Payer: United Healthcare All Payer |
$1,336.90
|
|
|
SION BLUE PTCA GW 180CM
|
Facility
|
OP
|
$1,519.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$1,458.43 |
| Rate for Payer: Aetna Commercial |
$1,169.78
|
| Rate for Payer: Anthem Medicaid |
$522.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.98
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,260.94
|
| Rate for Payer: First Health Commercial |
$1,443.24
|
| Rate for Payer: Humana Commercial |
$1,291.32
|
| Rate for Payer: Humana KY Medicaid |
$522.45
|
| Rate for Payer: Kentucky WC Medicaid |
$527.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$532.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,336.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,215.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,321.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.25
|
| Rate for Payer: PHCS Commercial |
$1,458.43
|
| Rate for Payer: United Healthcare All Payer |
$1,336.90
|
|
|
SION BLUE PTCA GW 300CM
|
Facility
|
IP
|
$1,519.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$1,458.43 |
| Rate for Payer: Aetna Commercial |
$1,169.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.98
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,260.94
|
| Rate for Payer: First Health Commercial |
$1,443.24
|
| Rate for Payer: Humana Commercial |
$1,291.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,336.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,215.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,321.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.25
|
| Rate for Payer: PHCS Commercial |
$1,458.43
|
| Rate for Payer: United Healthcare All Payer |
$1,336.90
|
|
|
SION BLUE PTCA GW 300CM
|
Facility
|
OP
|
$1,519.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$1,458.43 |
| Rate for Payer: Aetna Commercial |
$1,169.78
|
| Rate for Payer: Anthem Medicaid |
$522.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.98
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,260.94
|
| Rate for Payer: First Health Commercial |
$1,443.24
|
| Rate for Payer: Humana Commercial |
$1,291.32
|
| Rate for Payer: Humana KY Medicaid |
$522.45
|
| Rate for Payer: Kentucky WC Medicaid |
$527.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$532.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,336.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,215.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,321.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.25
|
| Rate for Payer: PHCS Commercial |
$1,458.43
|
| Rate for Payer: United Healthcare All Payer |
$1,336.90
|
|
|
SION PTCA GW 180CM
|
Facility
|
OP
|
$1,824.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.32 |
| Max. Negotiated Rate |
$1,751.42 |
| Rate for Payer: Aetna Commercial |
$1,404.79
|
| Rate for Payer: Anthem Medicaid |
$627.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.03
|
| Rate for Payer: Cash Price |
$912.20
|
| Rate for Payer: Cigna Commercial |
$1,514.25
|
| Rate for Payer: First Health Commercial |
$1,733.18
|
| Rate for Payer: Humana Commercial |
$1,550.74
|
| Rate for Payer: Humana KY Medicaid |
$627.41
|
| Rate for Payer: Kentucky WC Medicaid |
$633.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,605.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,459.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.84
|
| Rate for Payer: PHCS Commercial |
$1,751.42
|
| Rate for Payer: United Healthcare All Payer |
$1,605.47
|
|
