|
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
|
Facility
|
OP
|
$1,846.31
|
|
|
Service Code
|
CPT 69436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,318.79 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
|
|
TYMPANOSTOMY(T
|
Facility
|
IP
|
$3,722.00
|
|
|
Service Code
|
HCPCS 69436
|
| Hospital Charge Code |
761T2421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.86 |
| Max. Negotiated Rate |
$3,573.12 |
| Rate for Payer: Aetna Commercial |
$2,865.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,903.16
|
| Rate for Payer: Cash Price |
$1,861.00
|
| Rate for Payer: Cigna Commercial |
$3,089.26
|
| Rate for Payer: First Health Commercial |
$3,535.90
|
| Rate for Payer: Humana Commercial |
$3,163.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,052.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,275.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,791.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,153.82
|
| Rate for Payer: PHCS Commercial |
$3,573.12
|
| Rate for Payer: United Healthcare All Payer |
$3,275.36
|
|
|
TYMPANOSTOMY(T
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
HCPCS 69436
|
| Hospital Charge Code |
761T2421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.86 |
| Max. Negotiated Rate |
$3,573.12 |
| Rate for Payer: Aetna Commercial |
$2,865.94
|
| Rate for Payer: Anthem Medicaid |
$1,280.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,903.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,861.00
|
| Rate for Payer: Cash Price |
$1,861.00
|
| Rate for Payer: Cigna Commercial |
$3,089.26
|
| Rate for Payer: First Health Commercial |
$3,535.90
|
| Rate for Payer: Humana Commercial |
$3,163.70
|
| Rate for Payer: Humana KY Medicaid |
$1,280.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,293.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,052.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,275.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,791.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,153.82
|
| Rate for Payer: PHCS Commercial |
$3,573.12
|
| Rate for Payer: United Healthcare All Payer |
$3,275.36
|
|
|
TYMPANOSTOMY W/TUB INSERTION
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
76102420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.80 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.60
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
TYMPANOSTOMY W/TUB INSERTION
|
Professional
|
Both
|
$2,060.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
76102420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$2,060.00 |
| Rate for Payer: Aetna Commercial |
$184.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.31
|
| Rate for Payer: Anthem Medicaid |
$64.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,060.00
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$266.62
|
| Rate for Payer: Healthspan PPO |
$240.89
|
| Rate for Payer: Humana Medicaid |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$166.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.91
|
| Rate for Payer: Molina Healthcare Passport |
$64.62
|
| Rate for Payer: Multiplan PHCS |
$1,236.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,442.00
|
| Rate for Payer: UHCCP Medicaid |
$70.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.27
|
|
|
TYMPANOSTOMY W/TUB INSERTION
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
76102420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.80 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.60
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
TYMPANOSTOMY W/TUB INSERTION(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
761P2420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$184.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.31
|
| Rate for Payer: Anthem Medicaid |
$64.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$266.62
|
| Rate for Payer: Healthspan PPO |
$240.89
|
| Rate for Payer: Humana Medicaid |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$166.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.91
|
| Rate for Payer: Molina Healthcare Passport |
$64.62
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$70.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.27
|
|
|
TYMPANOSTOMY W/TUB INSERTION(T
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
761T2420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$1,689.60 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem Medicaid |
$605.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,460.80
|
| Rate for Payer: First Health Commercial |
$1,672.00
|
| Rate for Payer: Humana Commercial |
$1,496.00
|
| Rate for Payer: Humana KY Medicaid |
$605.26
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$611.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.60
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
TYMPANOSTOMY W/TUB INSERTION(T
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
761T2420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$1,689.60 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,460.80
|
| Rate for Payer: First Health Commercial |
$1,672.00
|
| Rate for Payer: Humana Commercial |
$1,496.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.60
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
TYPHOID VACCINE IM
|
Professional
|
Both
|
$292.75
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
77000035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.46 |
| Max. Negotiated Rate |
$292.75 |
| Rate for Payer: Buckeye Medicare Advantage |
$292.75
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$220.19
|
| Rate for Payer: Multiplan PHCS |
$175.65
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$204.92
|
| Rate for Payer: UHCCP Medicaid |
$102.46
|
|
|
TYPHOID VACCINE IM
|
Facility
|
OP
|
$292.75
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
77000035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.06 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Aetna Commercial |
$225.42
|
| Rate for Payer: Anthem Medicaid |
$100.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.34
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cigna Commercial |
$242.98
|
| Rate for Payer: First Health Commercial |
$278.11
|
| Rate for Payer: Humana Commercial |
$248.84
|
| Rate for Payer: Humana KY Medicaid |
$100.68
|
| Rate for Payer: Kentucky WC Medicaid |
$101.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.62
|
| Rate for Payer: Ohio Health Group HMO |
$219.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.75
|
| Rate for Payer: PHCS Commercial |
$281.04
|
| Rate for Payer: United Healthcare All Payer |
$257.62
|
|
|
TYPHOID VACCINE IM
|
Facility
|
IP
|
$292.75
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
77000035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.06 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Aetna Commercial |
$225.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.34
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cigna Commercial |
$242.98
|
| Rate for Payer: First Health Commercial |
$278.11
|
| Rate for Payer: Humana Commercial |
$248.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.62
|
| Rate for Payer: Ohio Health Group HMO |
$219.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.75
|
| Rate for Payer: PHCS Commercial |
$281.04
|
| Rate for Payer: United Healthcare All Payer |
$257.62
|
|
|
TYPHOID VACCINE IM(T
|
Facility
|
OP
|
$292.75
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
770T0035
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$38.06 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Aetna Commercial |
$225.42
|
| Rate for Payer: Anthem Medicaid |
$100.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.34
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cigna Commercial |
$242.98
|
| Rate for Payer: First Health Commercial |
$278.11
|
| Rate for Payer: Humana Commercial |
$248.84
|
| Rate for Payer: Humana KY Medicaid |
$100.68
|
| Rate for Payer: Kentucky WC Medicaid |
$101.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.62
|
| Rate for Payer: Ohio Health Group HMO |
$219.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.75
|
| Rate for Payer: PHCS Commercial |
$281.04
|
| Rate for Payer: United Healthcare All Payer |
$257.62
|
|
|
TYPHOID VACCINE IM(T
|
Facility
|
IP
|
$292.75
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
770T0035
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$38.06 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Aetna Commercial |
$225.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.34
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cigna Commercial |
$242.98
|
| Rate for Payer: First Health Commercial |
$278.11
|
| Rate for Payer: Humana Commercial |
$248.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.62
|
| Rate for Payer: Ohio Health Group HMO |
$219.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.75
|
| Rate for Payer: PHCS Commercial |
$281.04
|
| Rate for Payer: United Healthcare All Payer |
$257.62
|
|
|
TYSABRI 300 MG/15ML VL EA 1 MG
|
Facility
|
OP
|
$9,959.35
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
25002259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$9,560.98 |
| Rate for Payer: Aetna Commercial |
$7,668.70
|
| Rate for Payer: Anthem Medicaid |
$3,425.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,768.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.01
|
| Rate for Payer: Cash Price |
$4,979.68
|
| Rate for Payer: Cash Price |
$4,979.68
|
| Rate for Payer: Cigna Commercial |
$8,266.26
|
| Rate for Payer: First Health Commercial |
$9,461.38
|
| Rate for Payer: Humana Commercial |
$8,465.45
|
| Rate for Payer: Humana KY Medicaid |
$3,425.02
|
| Rate for Payer: Humana Medicare Advantage |
$24.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,459.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,166.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,350.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,493.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,764.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,469.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,991.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,087.40
|
| Rate for Payer: PHCS Commercial |
$9,560.98
|
| Rate for Payer: United Healthcare All Payer |
$8,764.23
|
|
|
TYSABRI 300 MG/15ML VL EA 1 MG
|
Facility
|
IP
|
$9,959.35
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
25002259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,294.72 |
| Max. Negotiated Rate |
$9,560.98 |
| Rate for Payer: Aetna Commercial |
$7,668.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,768.29
|
| Rate for Payer: Cash Price |
$4,979.68
|
| Rate for Payer: Cigna Commercial |
$8,266.26
|
| Rate for Payer: First Health Commercial |
$9,461.38
|
| Rate for Payer: Humana Commercial |
$8,465.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,166.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,350.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,987.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,764.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,469.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,991.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,087.40
|
| Rate for Payer: PHCS Commercial |
$9,560.98
|
| Rate for Payer: United Healthcare All Payer |
$8,764.23
|
|
|
TZANCK SMEAR
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30001329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.45
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.04
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
TZANCK SMEAR
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30002031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$28.16
|
| Rate for Payer: Healthspan PPO |
$6.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.44
|
| Rate for Payer: Multiplan PHCS |
$77.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.30
|
| Rate for Payer: UHCCP Medicaid |
$45.15
|
|
|
TZANCK SMEAR
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30002031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$44.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.99
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$44.36
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Kentucky WC Medicaid |
$44.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
TZANCK SMEAR
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30002031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
TZANCK SMEAR
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30001329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem Medicaid |
$28.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.99
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Humana KY Medicaid |
$28.89
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Kentucky WC Medicaid |
$29.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.04
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
TZANCK SMEAR (P
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
300P2031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$28.16
|
| Rate for Payer: Healthspan PPO |
$6.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.44
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
|
|
TZANCK SMEAR (T
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
300T2031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem Medicaid |
$28.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.99
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Humana KY Medicaid |
$28.89
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Kentucky WC Medicaid |
$29.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.04
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
TZANCK SMEAR (T
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
300T2031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.45
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.04
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
UA W/ MICRO
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
30000177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna Commercial |
$5.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.00
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: Healthspan PPO |
$3.32
|
| Rate for Payer: Multiplan PHCS |
$24.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.70
|
| Rate for Payer: UHCCP Medicaid |
$14.35
|
|
