|
MYOCRD IMG PET RST&STRS CT
|
Facility
|
OP
|
$4,762.00
|
|
|
Service Code
|
HCPCS 78431
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,637.65 |
| Max. Negotiated Rate |
$4,571.52 |
| Rate for Payer: Aetna Commercial |
$3,666.74
|
| Rate for Payer: Anthem Medicaid |
$1,637.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,079.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,714.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,911.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,807.22
|
| Rate for Payer: Cash Price |
$2,381.00
|
| Rate for Payer: Cash Price |
$2,381.00
|
| Rate for Payer: Cigna Commercial |
$3,952.46
|
| Rate for Payer: First Health Commercial |
$4,523.90
|
| Rate for Payer: Humana Commercial |
$4,047.70
|
| Rate for Payer: Humana KY Medicaid |
$1,637.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,079.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,904.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,514.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,670.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,190.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,809.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,142.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,285.78
|
| Rate for Payer: PHCS Commercial |
$4,571.52
|
| Rate for Payer: United Healthcare All Payer |
$4,190.56
|
|
|
MYOFLEX(TRIETHANOLAMINE)10 2OZ
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 41167005723
|
| Hospital Charge Code |
25001034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| 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 |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: First Health Commercial |
$0.06
|
| Rate for Payer: Humana Commercial |
$0.05
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.05
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.04
|
| Rate for Payer: PHCS Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Payer |
$0.05
|
|
|
MYOFLEX(TRIETHANOLAMINE)10 2OZ
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 41167005723
|
| Hospital Charge Code |
25001034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: First Health Commercial |
$0.06
|
| Rate for Payer: Humana Commercial |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.05
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.04
|
| Rate for Payer: PHCS Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Payer |
$0.05
|
|
|
MYOMECTOMY
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
76102209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
MYOMECTOMY
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
76102209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$488.28 |
| Max. Negotiated Rate |
$1,388.04 |
| Rate for Payer: Aetna Commercial |
$1,388.04
|
| Rate for Payer: Ambetter Exchange |
$872.46
|
| Rate for Payer: Anthem Medicaid |
$488.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$872.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$872.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,046.95
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,349.89
|
| Rate for Payer: Healthspan PPO |
$1,343.97
|
| Rate for Payer: Humana Medicaid |
$488.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,194.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$872.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$872.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$498.05
|
| Rate for Payer: Molina Healthcare Passport |
$488.28
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,134.20
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$872.46
|
|
|
MYOMECTOMY
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
76102209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
MYOMECTOMY(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
761P2209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$488.28 |
| Max. Negotiated Rate |
$1,388.04 |
| Rate for Payer: Aetna Commercial |
$1,388.04
|
| Rate for Payer: Ambetter Exchange |
$872.46
|
| Rate for Payer: Anthem Medicaid |
$488.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$872.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$872.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,046.95
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,349.89
|
| Rate for Payer: Healthspan PPO |
$1,343.97
|
| Rate for Payer: Humana Medicaid |
$488.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,194.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$872.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$872.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$498.05
|
| Rate for Payer: Molina Healthcare Passport |
$488.28
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,134.20
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$872.46
|
|
|
MYRBETRIQ 25MG TABLET (ER)
|
Facility
|
IP
|
$32.34
|
|
|
Service Code
|
NDC 469260130
|
| Hospital Charge Code |
25003244
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Aetna Commercial |
$24.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.23
|
| Rate for Payer: Cash Price |
$16.17
|
| Rate for Payer: Cigna Commercial |
$26.84
|
| Rate for Payer: First Health Commercial |
$30.72
|
| Rate for Payer: Humana Commercial |
$27.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.46
|
| Rate for Payer: Ohio Health Group HMO |
$24.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.31
|
| Rate for Payer: PHCS Commercial |
$31.05
|
| Rate for Payer: United Healthcare All Payer |
$28.46
|
|
|
MYRBETRIQ 25MG TABLET (ER)
|
Facility
|
OP
|
$32.34
|
|
|
Service Code
|
NDC 469260130
|
| Hospital Charge Code |
25003244
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Aetna Commercial |
$24.90
|
| Rate for Payer: Anthem Medicaid |
$11.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.23
|
| Rate for Payer: Cash Price |
$16.17
|
| Rate for Payer: Cigna Commercial |
$26.84
|
| Rate for Payer: First Health Commercial |
$30.72
|
| Rate for Payer: Humana Commercial |
$27.49
|
| Rate for Payer: Humana KY Medicaid |
$11.12
|
| Rate for Payer: Kentucky WC Medicaid |
$11.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.46
|
| Rate for Payer: Ohio Health Group HMO |
$24.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.31
|
| Rate for Payer: PHCS Commercial |
$31.05
|
| Rate for Payer: United Healthcare All Payer |
$28.46
|
|
|
MYRBETRIQ 50MG TABLET (ER)
|
Facility
|
OP
|
$32.34
|
|
|
Service Code
|
NDC 469260230
|
| Hospital Charge Code |
25003245
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Aetna Commercial |
$24.90
|
| Rate for Payer: Anthem Medicaid |
$11.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.23
|
| Rate for Payer: Cash Price |
$16.17
|
| Rate for Payer: Cigna Commercial |
$26.84
|
| Rate for Payer: First Health Commercial |
$30.72
|
| Rate for Payer: Humana Commercial |
$27.49
|
| Rate for Payer: Humana KY Medicaid |
$11.12
|
| Rate for Payer: Kentucky WC Medicaid |
$11.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.46
|
| Rate for Payer: Ohio Health Group HMO |
$24.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.31
|
| Rate for Payer: PHCS Commercial |
$31.05
|
| Rate for Payer: United Healthcare All Payer |
$28.46
|
|
|
MYRBETRIQ 50MG TABLET (ER)
|
Facility
|
IP
|
$32.34
|
|
|
Service Code
|
NDC 469260230
|
| Hospital Charge Code |
25003245
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Aetna Commercial |
$24.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.23
|
| Rate for Payer: Cash Price |
$16.17
|
| Rate for Payer: Cigna Commercial |
$26.84
|
| Rate for Payer: First Health Commercial |
$30.72
|
| Rate for Payer: Humana Commercial |
$27.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.46
|
| Rate for Payer: Ohio Health Group HMO |
$24.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.31
|
| Rate for Payer: PHCS Commercial |
$31.05
|
| Rate for Payer: United Healthcare All Payer |
$28.46
|
|
|
MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA)
|
Facility
|
OP
|
$4,195.14
|
|
|
Service Code
|
CPT 69620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,996.53 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
|
|
MYRINGOTOMY
|
Facility
|
OP
|
$2,152.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
36001285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$2,065.92 |
| Rate for Payer: Aetna Commercial |
$1,657.04
|
| Rate for Payer: Anthem Medicaid |
$740.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,678.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cigna Commercial |
$1,786.16
|
| Rate for Payer: First Health Commercial |
$2,044.40
|
| Rate for Payer: Humana Commercial |
$1,829.20
|
| Rate for Payer: Humana KY Medicaid |
$740.07
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$747.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,764.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,588.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$754.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,893.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,614.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,872.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,484.88
|
| Rate for Payer: PHCS Commercial |
$2,065.92
|
| Rate for Payer: United Healthcare All Payer |
$1,893.76
|
|
|
MYRINGOTOMY
|
Facility
|
IP
|
$1,752.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
45000309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$525.60 |
| Max. Negotiated Rate |
$1,681.92 |
| Rate for Payer: Aetna Commercial |
$1,349.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.56
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cigna Commercial |
$1,454.16
|
| Rate for Payer: First Health Commercial |
$1,664.40
|
| Rate for Payer: Humana Commercial |
$1,489.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,292.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,208.88
|
| Rate for Payer: PHCS Commercial |
$1,681.92
|
| Rate for Payer: United Healthcare All Payer |
$1,541.76
|
|
|
MYRINGOTOMY
|
Facility
|
OP
|
$1,752.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
45000309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$1,681.92 |
| Rate for Payer: Aetna Commercial |
$1,349.04
|
| Rate for Payer: Anthem Medicaid |
$602.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cigna Commercial |
$1,454.16
|
| Rate for Payer: First Health Commercial |
$1,664.40
|
| Rate for Payer: Humana Commercial |
$1,489.20
|
| Rate for Payer: Humana KY Medicaid |
$602.51
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$608.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,292.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,208.88
|
| Rate for Payer: PHCS Commercial |
$1,681.92
|
| Rate for Payer: United Healthcare All Payer |
$1,541.76
|
|
|
MYRINGOTOMY
|
Facility
|
IP
|
$2,152.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
36001285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$645.60 |
| Max. Negotiated Rate |
$2,065.92 |
| Rate for Payer: Aetna Commercial |
$1,657.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,678.56
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cigna Commercial |
$1,786.16
|
| Rate for Payer: First Health Commercial |
$2,044.40
|
| Rate for Payer: Humana Commercial |
$1,829.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,764.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,588.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,893.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,614.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,872.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,484.88
|
| Rate for Payer: PHCS Commercial |
$2,065.92
|
| Rate for Payer: United Healthcare All Payer |
$1,893.76
|
|
|
MYRINGOTOMY
|
Facility
|
IP
|
$2,152.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
76102417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$645.60 |
| Max. Negotiated Rate |
$2,065.92 |
| Rate for Payer: Aetna Commercial |
$1,657.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,678.56
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cigna Commercial |
$1,786.16
|
| Rate for Payer: First Health Commercial |
$2,044.40
|
| Rate for Payer: Humana Commercial |
$1,829.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,764.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,588.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,893.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,614.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,872.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,484.88
|
| Rate for Payer: PHCS Commercial |
$2,065.92
|
| Rate for Payer: United Healthcare All Payer |
$1,893.76
|
|
|
MYRINGOTOMY
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
76102418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,376.29 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,081.54
|
| Rate for Payer: Anthem Medicaid |
$1,376.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,001.00
|
| 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 |
$2,996.53
|
| 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 |
$3,595.84
|
| 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 |
$3,201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,481.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,761.38
|
| Rate for Payer: PHCS Commercial |
$3,841.92
|
| Rate for Payer: United Healthcare All Payer |
$3,521.76
|
|
|
MYRINGOTOMY
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
76102417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$1,291.20 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Ambetter Exchange |
$112.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.43
|
| Rate for Payer: Anthem Medicaid |
$58.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$112.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$112.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.49
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cigna Commercial |
$256.78
|
| Rate for Payer: Healthspan PPO |
$230.38
|
| Rate for Payer: Humana Medicaid |
$58.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.17
|
| Rate for Payer: Molina Healthcare Passport |
$58.01
|
| Rate for Payer: Multiplan PHCS |
$1,291.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$146.78
|
| Rate for Payer: UHCCP Medicaid |
$64.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$112.91
|
|
|
MYRINGOTOMY
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
76102418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,200.60 |
| Max. Negotiated Rate |
$3,841.92 |
| Rate for Payer: Aetna Commercial |
$3,081.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.56
|
| 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: 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 |
$1,200.60
|
| 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 |
$3,201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,481.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,761.38
|
| Rate for Payer: PHCS Commercial |
$3,841.92
|
| Rate for Payer: United Healthcare All Payer |
$3,521.76
|
|
|
MYRINGOTOMY
|
Facility
|
OP
|
$2,152.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
76102417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$2,065.92 |
| Rate for Payer: Aetna Commercial |
$1,657.04
|
| Rate for Payer: Anthem Medicaid |
$740.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,678.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cigna Commercial |
$1,786.16
|
| Rate for Payer: First Health Commercial |
$2,044.40
|
| Rate for Payer: Humana Commercial |
$1,829.20
|
| Rate for Payer: Humana KY Medicaid |
$740.07
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$747.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,764.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,588.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$754.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,893.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,614.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,872.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,484.88
|
| Rate for Payer: PHCS Commercial |
$2,065.92
|
| Rate for Payer: United Healthcare All Payer |
$1,893.76
|
|
|
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 |
$2,401.20 |
| Rate for Payer: Aetna Commercial |
$215.53
|
| Rate for Payer: Ambetter Exchange |
$141.37
|
| Rate for Payer: Anthem Medicaid |
$83.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$141.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$141.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$169.64
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$141.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.37
|
| 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 |
$183.78
|
| Rate for Payer: UHCCP Medicaid |
$1,400.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$141.37
|
|
|
MYRINGOTOMY
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
36001285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$1,291.20 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Ambetter Exchange |
$112.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.43
|
| Rate for Payer: Anthem Medicaid |
$58.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$112.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$112.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.49
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cigna Commercial |
$256.78
|
| Rate for Payer: Healthspan PPO |
$230.38
|
| Rate for Payer: Humana Medicaid |
$58.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.17
|
| Rate for Payer: Molina Healthcare Passport |
$58.01
|
| Rate for Payer: Multiplan PHCS |
$1,291.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$146.78
|
| Rate for Payer: UHCCP Medicaid |
$64.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$112.91
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$4,195.14
|
|
|
Service Code
|
CPT 69421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,996.53 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
|
|
MYRINGOTOMY(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
761P2417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$256.78 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Ambetter Exchange |
$112.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.43
|
| Rate for Payer: Anthem Medicaid |
$58.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$112.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$112.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.49
|
| 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 |
$58.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.17
|
| Rate for Payer: Molina Healthcare Passport |
$58.01
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$146.78
|
| Rate for Payer: UHCCP Medicaid |
$64.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$112.91
|
|
