|
MYRINGOTOMY
|
Facility
|
IP
|
$1,897.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
36001285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$246.61 |
| Max. Negotiated Rate |
$1,821.12 |
| Rate for Payer: Aetna Commercial |
$1,460.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,479.66
|
| Rate for Payer: Cash Price |
$948.50
|
| Rate for Payer: Cigna Commercial |
$1,574.51
|
| Rate for Payer: First Health Commercial |
$1,802.15
|
| Rate for Payer: Humana Commercial |
$1,612.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,555.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,669.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.07
|
| Rate for Payer: PHCS Commercial |
$1,821.12
|
| Rate for Payer: United Healthcare All Payer |
$1,669.36
|
|
|
MYRINGOTOMY
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
45000309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
MYRINGOTOMY
|
Facility
|
OP
|
$2,045.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
76102417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.23 |
| Max. Negotiated Rate |
$1,963.20 |
| Rate for Payer: Aetna Commercial |
$1,574.65
|
| Rate for Payer: Anthem Medicaid |
$703.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,595.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$1,022.50
|
| Rate for Payer: Cash Price |
$1,022.50
|
| Rate for Payer: Cigna Commercial |
$1,697.35
|
| Rate for Payer: First Health Commercial |
$1,942.75
|
| Rate for Payer: Humana Commercial |
$1,738.25
|
| Rate for Payer: Humana KY Medicaid |
$703.28
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$710.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,676.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,509.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$717.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,799.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,533.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$633.95
|
| Rate for Payer: PHCS Commercial |
$1,963.20
|
| Rate for Payer: United Healthcare All Payer |
$1,799.60
|
|
|
MYRINGOTOMY
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
76102418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.26 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$3,081.54
|
| Rate for Payer: Anthem Medicaid |
$1,376.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$3,321.66
|
| Rate for Payer: First Health Commercial |
$3,801.90
|
| Rate for Payer: Humana Commercial |
$3,401.70
|
| Rate for Payer: Humana KY Medicaid |
$1,376.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,390.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,281.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,953.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,521.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,001.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.62
|
| Rate for Payer: PHCS Commercial |
$3,841.92
|
| Rate for Payer: United Healthcare All Payer |
$3,521.76
|
|
|
MYRINGOTOMY
|
Facility
|
OP
|
$1,897.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
36001285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.23 |
| Max. Negotiated Rate |
$1,821.12 |
| Rate for Payer: Aetna Commercial |
$1,460.69
|
| Rate for Payer: Anthem Medicaid |
$652.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,479.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$948.50
|
| Rate for Payer: Cash Price |
$948.50
|
| Rate for Payer: Cigna Commercial |
$1,574.51
|
| Rate for Payer: First Health Commercial |
$1,802.15
|
| Rate for Payer: Humana Commercial |
$1,612.45
|
| Rate for Payer: Humana KY Medicaid |
$652.38
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$659.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,555.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,669.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.07
|
| Rate for Payer: PHCS Commercial |
$1,821.12
|
| Rate for Payer: United Healthcare All Payer |
$1,669.36
|
|
|
MYRINGOTOMY
|
Professional
|
Both
|
$2,045.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
76102417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.76 |
| Max. Negotiated Rate |
$2,045.00 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.43
|
| Rate for Payer: Anthem Medicaid |
$48.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,045.00
|
| Rate for Payer: Cash Price |
$1,022.50
|
| Rate for Payer: Cash Price |
$1,022.50
|
| Rate for Payer: Cigna Commercial |
$256.78
|
| Rate for Payer: Healthspan PPO |
$230.38
|
| Rate for Payer: Humana Medicaid |
$48.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.74
|
| Rate for Payer: Molina Healthcare Passport |
$48.76
|
| Rate for Payer: Multiplan PHCS |
$1,227.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,431.50
|
| Rate for Payer: UHCCP Medicaid |
$64.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.25
|
|
|
MYRINGOTOMY
|
Professional
|
Both
|
$1,897.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
36001285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$48.76 |
| Max. Negotiated Rate |
$1,897.00 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.43
|
| Rate for Payer: Anthem Medicaid |
$48.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,897.00
|
| Rate for Payer: Cash Price |
$948.50
|
| Rate for Payer: Cash Price |
$948.50
|
| Rate for Payer: Cigna Commercial |
$256.78
|
| Rate for Payer: Healthspan PPO |
$230.38
|
| Rate for Payer: Humana Medicaid |
$48.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.74
|
| Rate for Payer: Molina Healthcare Passport |
$48.76
|
| Rate for Payer: Multiplan PHCS |
$1,138.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,327.90
|
| Rate for Payer: UHCCP Medicaid |
$64.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.25
|
|
|
MYRINGOTOMY
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
76102418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.03 |
| Max. Negotiated Rate |
$4,002.00 |
| Rate for Payer: Aetna Commercial |
$215.53
|
| Rate for Payer: Anthem Medicaid |
$83.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,002.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$219.82
|
| Rate for Payer: Healthspan PPO |
$191.19
|
| Rate for Payer: Humana Medicaid |
$83.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.69
|
| Rate for Payer: Molina Healthcare Passport |
$83.03
|
| Rate for Payer: Multiplan PHCS |
$2,401.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,801.40
|
| Rate for Payer: UHCCP Medicaid |
$1,400.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.86
|
|
|
MYRINGOTOMY
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
45000309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$295.72 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$3,897.84
|
|
|
Service Code
|
CPT 69421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,784.17 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
|
|
MYRINGOTOMY(P
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
360P1285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$48.76 |
| Max. Negotiated Rate |
$256.78 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.43
|
| Rate for Payer: Anthem Medicaid |
$48.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$256.78
|
| Rate for Payer: Healthspan PPO |
$230.38
|
| Rate for Payer: Humana Medicaid |
$48.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.74
|
| Rate for Payer: Molina Healthcare Passport |
$48.76
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.00
|
| Rate for Payer: UHCCP Medicaid |
$64.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.25
|
|
|
MYRINGOTOMY(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
761P2417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.76 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.43
|
| Rate for Payer: Anthem Medicaid |
$48.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$256.78
|
| Rate for Payer: Healthspan PPO |
$230.38
|
| Rate for Payer: Humana Medicaid |
$48.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.74
|
| Rate for Payer: Molina Healthcare Passport |
$48.76
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$64.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.25
|
|
|
MYRINGOTOMY(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
761P2418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.03 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$215.53
|
| Rate for Payer: Anthem Medicaid |
$83.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$219.82
|
| Rate for Payer: Healthspan PPO |
$191.19
|
| Rate for Payer: Humana Medicaid |
$83.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.69
|
| Rate for Payer: Molina Healthcare Passport |
$83.03
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.86
|
|
|
MYRINGOTOMY(T
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
761T2418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Humana KY Medicaid |
$1,290.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,303.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
MYRINGOTOMY(T
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
360T1285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.23 |
| Max. Negotiated Rate |
$1,648.32 |
| Rate for Payer: Aetna Commercial |
$1,322.09
|
| Rate for Payer: Anthem Medicaid |
$590.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$858.50
|
| Rate for Payer: Cash Price |
$858.50
|
| Rate for Payer: Cigna Commercial |
$1,425.11
|
| Rate for Payer: First Health Commercial |
$1,631.15
|
| Rate for Payer: Humana Commercial |
$1,459.45
|
| Rate for Payer: Humana KY Medicaid |
$590.48
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$596.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,407.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$602.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,510.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,287.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.27
|
| Rate for Payer: PHCS Commercial |
$1,648.32
|
| Rate for Payer: United Healthcare All Payer |
$1,510.96
|
|
|
MYRINGOTOMY(T
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
360T1285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$223.21 |
| Max. Negotiated Rate |
$1,648.32 |
| Rate for Payer: Aetna Commercial |
$1,322.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.26
|
| Rate for Payer: Cash Price |
$858.50
|
| Rate for Payer: Cigna Commercial |
$1,425.11
|
| Rate for Payer: First Health Commercial |
$1,631.15
|
| Rate for Payer: Humana Commercial |
$1,459.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,407.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,510.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,287.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.27
|
| Rate for Payer: PHCS Commercial |
$1,648.32
|
| Rate for Payer: United Healthcare All Payer |
$1,510.96
|
|
|
MYRINGOTOMY(T
|
Facility
|
IP
|
$1,645.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
761T2417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$1,579.20 |
| Rate for Payer: Aetna Commercial |
$1,266.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,283.10
|
| Rate for Payer: Cash Price |
$822.50
|
| Rate for Payer: Cigna Commercial |
$1,365.35
|
| Rate for Payer: First Health Commercial |
$1,562.75
|
| Rate for Payer: Humana Commercial |
$1,398.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,348.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,214.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$493.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,447.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,233.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$329.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$509.95
|
| Rate for Payer: PHCS Commercial |
$1,579.20
|
| Rate for Payer: United Healthcare All Payer |
$1,447.60
|
|
|
MYRINGOTOMY(T
|
Facility
|
OP
|
$1,645.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
761T2417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.23 |
| Max. Negotiated Rate |
$1,579.20 |
| Rate for Payer: Aetna Commercial |
$1,266.65
|
| Rate for Payer: Anthem Medicaid |
$565.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,283.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$822.50
|
| Rate for Payer: Cash Price |
$822.50
|
| Rate for Payer: Cigna Commercial |
$1,365.35
|
| Rate for Payer: First Health Commercial |
$1,562.75
|
| Rate for Payer: Humana Commercial |
$1,398.25
|
| Rate for Payer: Humana KY Medicaid |
$565.72
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$571.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,348.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,214.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$577.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,447.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,233.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$329.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$509.95
|
| Rate for Payer: PHCS Commercial |
$1,579.20
|
| Rate for Payer: United Healthcare All Payer |
$1,447.60
|
|
|
MYRINGOTOMY(T
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
761T2418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
MYSOLINE (PRIMIDONE 250MG/1TAB
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
NDC 527123101
|
| Hospital Charge Code |
25001035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
MYSOLINE (PRIMIDONE 250MG/1TAB
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
NDC 527123101
|
| Hospital Charge Code |
25001035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
MYSOLINE (PRIMIDONE) 50MG/1TAB
|
Facility
|
OP
|
$5.01
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
25001036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Anthem Medicaid |
$1.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.91
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: First Health Commercial |
$4.76
|
| Rate for Payer: Humana Commercial |
$4.26
|
| Rate for Payer: Humana KY Medicaid |
$1.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.41
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
| Rate for Payer: Aetna Commercial |
$3.86
|
|
|
MYSOLINE (PRIMIDONE) 50MG/1TAB
|
Facility
|
IP
|
$5.01
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
25001036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.91
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: First Health Commercial |
$4.76
|
| Rate for Payer: Humana Commercial |
$4.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.41
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
|
MY WAY 1.5MG TABLET
|
Facility
|
OP
|
$30.50
|
|
|
Service Code
|
NDC 68180085211
|
| Hospital Charge Code |
25003879
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$29.28 |
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Anthem Medicaid |
$10.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.79
|
| Rate for Payer: Cash Price |
$15.25
|
| Rate for Payer: Cigna Commercial |
$25.32
|
| Rate for Payer: First Health Commercial |
$28.98
|
| Rate for Payer: Humana Commercial |
$25.92
|
| Rate for Payer: Humana KY Medicaid |
$10.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.84
|
| Rate for Payer: Ohio Health Group HMO |
$22.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.46
|
| Rate for Payer: PHCS Commercial |
$29.28
|
| Rate for Payer: United Healthcare All Payer |
$26.84
|
|
|
MY WAY 1.5MG TABLET
|
Facility
|
IP
|
$30.50
|
|
|
Service Code
|
NDC 68180085211
|
| Hospital Charge Code |
25003879
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$29.28 |
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.79
|
| Rate for Payer: Cash Price |
$15.25
|
| Rate for Payer: Cigna Commercial |
$25.32
|
| Rate for Payer: First Health Commercial |
$28.98
|
| Rate for Payer: Humana Commercial |
$25.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.84
|
| Rate for Payer: Ohio Health Group HMO |
$22.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.46
|
| Rate for Payer: PHCS Commercial |
$29.28
|
| Rate for Payer: United Healthcare All Payer |
$26.84
|
|
