|
TILT TABLE
|
Facility
|
IP
|
$2,092.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
48000107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$627.60 |
| Max. Negotiated Rate |
$2,008.32 |
| Rate for Payer: Aetna Commercial |
$1,610.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,631.76
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$1,736.36
|
| Rate for Payer: First Health Commercial |
$1,987.40
|
| Rate for Payer: Humana Commercial |
$1,778.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,715.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,543.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,840.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,569.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,820.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.48
|
| Rate for Payer: PHCS Commercial |
$2,008.32
|
| Rate for Payer: United Healthcare All Payer |
$1,840.96
|
|
|
TILT TABLE
|
Facility
|
IP
|
$1,706.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
48000056
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$511.80 |
| Max. Negotiated Rate |
$1,637.76 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,330.68
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Cigna Commercial |
$1,415.98
|
| Rate for Payer: First Health Commercial |
$1,620.70
|
| Rate for Payer: Humana Commercial |
$1,450.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,501.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,279.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,484.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,177.14
|
| Rate for Payer: PHCS Commercial |
$1,637.76
|
| Rate for Payer: United Healthcare All Payer |
$1,501.28
|
|
|
TILT TABLE
|
Facility
|
OP
|
$1,706.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
48000056
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$1,637.76 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Anthem Medicaid |
$586.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,330.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Cigna Commercial |
$1,415.98
|
| Rate for Payer: First Health Commercial |
$1,620.70
|
| Rate for Payer: Humana Commercial |
$1,450.10
|
| Rate for Payer: Humana KY Medicaid |
$586.69
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$592.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,501.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,279.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,484.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,177.14
|
| Rate for Payer: PHCS Commercial |
$1,637.76
|
| Rate for Payer: United Healthcare All Payer |
$1,501.28
|
|
|
TILT TABLE
|
Facility
|
OP
|
$2,092.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
48000107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$2,008.32 |
| Rate for Payer: Aetna Commercial |
$1,610.84
|
| Rate for Payer: Anthem Medicaid |
$719.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,631.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$1,736.36
|
| Rate for Payer: First Health Commercial |
$1,987.40
|
| Rate for Payer: Humana Commercial |
$1,778.20
|
| Rate for Payer: Humana KY Medicaid |
$719.44
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$726.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,715.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,543.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$733.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,840.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,569.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,820.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.48
|
| Rate for Payer: PHCS Commercial |
$2,008.32
|
| Rate for Payer: United Healthcare All Payer |
$1,840.96
|
|
|
TILT TABLE
|
Professional
|
Both
|
$2,092.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
48000107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$125.57 |
| Max. Negotiated Rate |
$1,255.20 |
| Rate for Payer: Aetna Commercial |
$276.78
|
| Rate for Payer: Ambetter Exchange |
$150.74
|
| Rate for Payer: Anthem Medicaid |
$125.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$150.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$180.89
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$257.91
|
| Rate for Payer: Healthspan PPO |
$260.18
|
| Rate for Payer: Humana Medicaid |
$125.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$150.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.08
|
| Rate for Payer: Molina Healthcare Passport |
$125.57
|
| Rate for Payer: Multiplan PHCS |
$1,255.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$195.96
|
| Rate for Payer: UHCCP Medicaid |
$732.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$150.74
|
|
|
TILT TABLE(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
480P0107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$276.78 |
| Rate for Payer: Aetna Commercial |
$276.78
|
| Rate for Payer: Ambetter Exchange |
$150.74
|
| Rate for Payer: Anthem Medicaid |
$125.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$150.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$180.89
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$257.91
|
| Rate for Payer: Healthspan PPO |
$260.18
|
| Rate for Payer: Humana Medicaid |
$125.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$150.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.08
|
| Rate for Payer: Molina Healthcare Passport |
$125.57
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$195.96
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$150.74
|
|
|
TILT TABLE(T
|
Facility
|
IP
|
$1,817.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
480T0107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$545.10 |
| Max. Negotiated Rate |
$1,744.32 |
| Rate for Payer: Aetna Commercial |
$1,399.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.26
|
| Rate for Payer: Cash Price |
$908.50
|
| Rate for Payer: Cigna Commercial |
$1,508.11
|
| Rate for Payer: First Health Commercial |
$1,726.15
|
| Rate for Payer: Humana Commercial |
$1,544.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,580.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,253.73
|
| Rate for Payer: PHCS Commercial |
$1,744.32
|
| Rate for Payer: United Healthcare All Payer |
$1,598.96
|
|
|
TILT TABLE(T
|
Facility
|
OP
|
$1,817.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
480T0107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$1,744.32 |
| Rate for Payer: Aetna Commercial |
$1,399.09
|
| Rate for Payer: Anthem Medicaid |
$624.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$908.50
|
| Rate for Payer: Cash Price |
$908.50
|
| Rate for Payer: Cigna Commercial |
$1,508.11
|
| Rate for Payer: First Health Commercial |
$1,726.15
|
| Rate for Payer: Humana Commercial |
$1,544.45
|
| Rate for Payer: Humana KY Medicaid |
$624.87
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$631.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,580.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,253.73
|
| Rate for Payer: PHCS Commercial |
$1,744.32
|
| Rate for Payer: United Healthcare All Payer |
$1,598.96
|
|
|
TIMED SQ INJECTION MEDONC
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 96377
|
| Hospital Charge Code |
94000004
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
TIMED SQ INJECTION MEDONC
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 96377
|
| Hospital Charge Code |
94000004
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$40.58 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem Medicaid |
$40.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana KY Medicaid |
$40.58
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$40.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
TIMOLOL 5MG TABLET
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
NDC 378005501
|
| Hospital Charge Code |
25001549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.10
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cigna Commercial |
$7.55
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.01
|
| Rate for Payer: Ohio Health Group HMO |
$6.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.28
|
| Rate for Payer: PHCS Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Payer |
$8.01
|
|
|
TIMOLOL 5MG TABLET
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
NDC 378005501
|
| Hospital Charge Code |
25001549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.01
|
| Rate for Payer: Anthem Medicaid |
$3.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.10
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cigna Commercial |
$7.55
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.74
|
| Rate for Payer: Humana KY Medicaid |
$3.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.01
|
| Rate for Payer: Ohio Health Group HMO |
$6.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.28
|
| Rate for Payer: PHCS Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Payer |
$8.01
|
|
|
TIMOPTIC(TIMOLOL) 0.5% OP 5ML
|
Facility
|
IP
|
$0.85
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
25001550
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna Commercial |
$0.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.66
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna Commercial |
$0.71
|
| Rate for Payer: First Health Commercial |
$0.81
|
| Rate for Payer: Humana Commercial |
$0.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.75
|
| Rate for Payer: Ohio Health Group HMO |
$0.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.59
|
| Rate for Payer: PHCS Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Payer |
$0.75
|
|
|
TIMOPTIC(TIMOLOL) 0.5% OP 5ML
|
Facility
|
OP
|
$0.85
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
25001550
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna Commercial |
$0.65
|
| Rate for Payer: Anthem Medicaid |
$0.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.66
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna Commercial |
$0.71
|
| Rate for Payer: First Health Commercial |
$0.81
|
| Rate for Payer: Humana Commercial |
$0.72
|
| Rate for Payer: Humana KY Medicaid |
$0.29
|
| Rate for Payer: Kentucky WC Medicaid |
$0.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.75
|
| Rate for Payer: Ohio Health Group HMO |
$0.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.59
|
| Rate for Payer: PHCS Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Payer |
$0.75
|
|
|
TIMOPTIC(TIMOLOL).25% OP 5ML
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 64980051305
|
| Hospital Charge Code |
25001551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna Commercial |
$0.62
|
| Rate for Payer: Anthem Medicaid |
$0.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.62
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna Commercial |
$0.66
|
| Rate for Payer: First Health Commercial |
$0.76
|
| Rate for Payer: Humana Commercial |
$0.68
|
| Rate for Payer: Humana KY Medicaid |
$0.28
|
| Rate for Payer: Kentucky WC Medicaid |
$0.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.70
|
| Rate for Payer: Ohio Health Group HMO |
$0.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.55
|
| Rate for Payer: PHCS Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Payer |
$0.70
|
|
|
TIMOPTIC(TIMOLOL).25% OP 5ML
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 64980051305
|
| Hospital Charge Code |
25001551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna Commercial |
$0.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.62
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna Commercial |
$0.66
|
| Rate for Payer: First Health Commercial |
$0.76
|
| Rate for Payer: Humana Commercial |
$0.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.70
|
| Rate for Payer: Ohio Health Group HMO |
$0.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.55
|
| Rate for Payer: PHCS Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Payer |
$0.70
|
|
|
TIMOPTIC(TIMOLOL)SOL-GEL5 ML
|
Facility
|
OP
|
$5.77
|
|
|
Service Code
|
NDC 61314022405
|
| Hospital Charge Code |
25001552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: Anthem Medicaid |
$1.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.50
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna Commercial |
$4.79
|
| Rate for Payer: First Health Commercial |
$5.48
|
| Rate for Payer: Humana Commercial |
$4.90
|
| Rate for Payer: Humana KY Medicaid |
$1.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.08
|
| Rate for Payer: Ohio Health Group HMO |
$4.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.98
|
| Rate for Payer: PHCS Commercial |
$5.54
|
| Rate for Payer: United Healthcare All Payer |
$5.08
|
|
|
TIMOPTIC(TIMOLOL)SOL-GEL5 ML
|
Facility
|
IP
|
$5.77
|
|
|
Service Code
|
NDC 61314022405
|
| Hospital Charge Code |
25001552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.50
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna Commercial |
$4.79
|
| Rate for Payer: First Health Commercial |
$5.48
|
| Rate for Payer: Humana Commercial |
$4.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.08
|
| Rate for Payer: Ohio Health Group HMO |
$4.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.98
|
| Rate for Payer: PHCS Commercial |
$5.54
|
| Rate for Payer: United Healthcare All Payer |
$5.08
|
|
|
TIMOPTIC-XE (TIMOLOL) 2.5%/5ML
|
Facility
|
IP
|
$5.92
|
|
|
Service Code
|
NDC 61314022505
|
| Hospital Charge Code |
25001553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.62
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cigna Commercial |
$4.91
|
| Rate for Payer: First Health Commercial |
$5.62
|
| Rate for Payer: Humana Commercial |
$5.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.21
|
| Rate for Payer: Ohio Health Group HMO |
$4.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.08
|
| Rate for Payer: PHCS Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Payer |
$5.21
|
|
|
TIMOPTIC-XE (TIMOLOL) 2.5%/5ML
|
Facility
|
OP
|
$5.92
|
|
|
Service Code
|
NDC 61314022505
|
| Hospital Charge Code |
25001553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: Anthem Medicaid |
$2.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.62
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cigna Commercial |
$4.91
|
| Rate for Payer: First Health Commercial |
$5.62
|
| Rate for Payer: Humana Commercial |
$5.03
|
| Rate for Payer: Humana KY Medicaid |
$2.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.21
|
| Rate for Payer: Ohio Health Group HMO |
$4.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.08
|
| Rate for Payer: PHCS Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Payer |
$5.21
|
|
|
TIMOTHY GRASS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000722
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
TIMOTHY GRASS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000722
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
TINACTIN(TOLNAFTATE) 1% C 15GM
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 51672202001
|
| Hospital Charge Code |
25001554
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna Commercial |
$0.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna Commercial |
$0.17
|
| Rate for Payer: First Health Commercial |
$0.20
|
| Rate for Payer: Humana Commercial |
$0.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.18
|
| Rate for Payer: Ohio Health Group HMO |
$0.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.14
|
| Rate for Payer: PHCS Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Payer |
$0.18
|
|
|
TINACTIN(TOLNAFTATE) 1% C 15GM
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 51672202001
|
| Hospital Charge Code |
25001554
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna Commercial |
$0.16
|
| Rate for Payer: Anthem Medicaid |
$0.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna Commercial |
$0.17
|
| Rate for Payer: First Health Commercial |
$0.20
|
| Rate for Payer: Humana Commercial |
$0.18
|
| Rate for Payer: Humana KY Medicaid |
$0.07
|
| Rate for Payer: Kentucky WC Medicaid |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.18
|
| Rate for Payer: Ohio Health Group HMO |
$0.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.14
|
| Rate for Payer: PHCS Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Payer |
$0.18
|
|
|
TINCTURE OF BENZOIN SPRAY 4OZ
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25001555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Anthem Medicaid |
$0.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna Commercial |
$0.22
|
| Rate for Payer: First Health Commercial |
$0.25
|
| Rate for Payer: Humana Commercial |
$0.22
|
| Rate for Payer: Humana KY Medicaid |
$0.09
|
| Rate for Payer: Kentucky WC Medicaid |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.23
|
| Rate for Payer: Ohio Health Group HMO |
$0.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.18
|
| Rate for Payer: PHCS Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Payer |
$0.23
|
|
