|
TYLENOL(ACETAMINOPHE 120MG/1EA
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
25001620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
TYLENOL(ACETAMINOPHE 120MG/1EA
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
25001620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
TYLENOL EQ 40MG/1.25ML ORL SOL
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 121197100
|
| Hospital Charge Code |
25003548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
TYLENOL EQ 40MG/1.25ML ORL SOL
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 121197100
|
| Hospital Charge Code |
25003548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
TYLENOL ES (ACETAMI 500MG/1TAB
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 904673061
|
| Hospital Charge Code |
25001616
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
TYLENOL ES (ACETAMI 500MG/1TAB
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 904673061
|
| Hospital Charge Code |
25001616
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION OF PERFORATION FOR CLOSURE, WITH OR WITHOUT PATCH
|
Facility
|
OP
|
$1,916.14
|
|
|
Service Code
|
CPT 69610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,368.67 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
|
|
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$7,652.33
|
|
|
Service Code
|
CPT 69631
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,465.95 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
|
|
TYMPANOPLASTY W/O MASTOIDECTOM
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 69631
|
| Hospital Charge Code |
761P2430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.12 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,245.18
|
| Rate for Payer: Ambetter Exchange |
$819.16
|
| Rate for Payer: Anthem Medicaid |
$647.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$819.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$819.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$982.99
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,212.73
|
| Rate for Payer: Healthspan PPO |
$1,104.53
|
| Rate for Payer: Humana Medicaid |
$647.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,124.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$819.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$819.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$660.06
|
| Rate for Payer: Molina Healthcare Passport |
$647.12
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,064.91
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$653.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$819.16
|
|
|
TYMPANOPLASTY W/O MASTOIDECTOM
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 69631
|
| Hospital Charge Code |
76102430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
TYMPANOPLASTY W/O MASTOIDECTOM
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 69631
|
| Hospital Charge Code |
76102430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$859.75 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
TYMPANOPLASTY W/O MASTOIDECTOM
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 69631
|
| Hospital Charge Code |
76102430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.12 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,245.18
|
| Rate for Payer: Ambetter Exchange |
$819.16
|
| Rate for Payer: Anthem Medicaid |
$647.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$819.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$819.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$982.99
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,212.73
|
| Rate for Payer: Healthspan PPO |
$1,104.53
|
| Rate for Payer: Humana Medicaid |
$647.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,124.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$819.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$819.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$660.06
|
| Rate for Payer: Molina Healthcare Passport |
$647.12
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,064.91
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$653.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$819.16
|
|
|
TYMPANOSTOMY
|
Facility
|
IP
|
$4,422.00
|
|
|
Service Code
|
HCPCS 69436
|
| Hospital Charge Code |
76102421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,326.60 |
| Max. Negotiated Rate |
$4,245.12 |
| Rate for Payer: Aetna Commercial |
$3,404.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,449.16
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cigna Commercial |
$3,670.26
|
| Rate for Payer: First Health Commercial |
$4,200.90
|
| Rate for Payer: Humana Commercial |
$3,758.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,626.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,263.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,326.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,891.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,537.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,847.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,051.18
|
| Rate for Payer: PHCS Commercial |
$4,245.12
|
| Rate for Payer: United Healthcare All Payer |
$3,891.36
|
|
|
TYMPANOSTOMY
|
Facility
|
OP
|
$4,422.00
|
|
|
Service Code
|
HCPCS 69436
|
| Hospital Charge Code |
76102421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,368.67 |
| Max. Negotiated Rate |
$4,245.12 |
| Rate for Payer: Aetna Commercial |
$3,404.94
|
| Rate for Payer: Anthem Medicaid |
$1,520.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,449.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cigna Commercial |
$3,670.26
|
| Rate for Payer: First Health Commercial |
$4,200.90
|
| Rate for Payer: Humana Commercial |
$3,758.70
|
| Rate for Payer: Humana KY Medicaid |
$1,520.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,536.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,626.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,263.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,551.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,891.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,537.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,847.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,051.18
|
| Rate for Payer: PHCS Commercial |
$4,245.12
|
| Rate for Payer: United Healthcare All Payer |
$3,891.36
|
|
|
TYMPANOSTOMY
|
Professional
|
Both
|
$4,422.00
|
|
|
Service Code
|
HCPCS 69436
|
| Hospital Charge Code |
76102421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.45 |
| Max. Negotiated Rate |
$2,653.20 |
| Rate for Payer: Aetna Commercial |
$235.42
|
| Rate for Payer: Ambetter Exchange |
$149.85
|
| Rate for Payer: Anthem Medicaid |
$122.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$149.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$149.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$179.82
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cigna Commercial |
$240.52
|
| Rate for Payer: Healthspan PPO |
$208.83
|
| Rate for Payer: Humana Medicaid |
$122.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$207.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$149.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$124.90
|
| Rate for Payer: Molina Healthcare Passport |
$122.45
|
| Rate for Payer: Multiplan PHCS |
$2,653.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$194.81
|
| Rate for Payer: UHCCP Medicaid |
$1,547.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$149.85
|
|
|
TYMPANOSTOMY(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 69436
|
| Hospital Charge Code |
761P2421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.45 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$235.42
|
| Rate for Payer: Ambetter Exchange |
$149.85
|
| Rate for Payer: Anthem Medicaid |
$122.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$149.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$149.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$179.82
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$240.52
|
| Rate for Payer: Healthspan PPO |
$208.83
|
| Rate for Payer: Humana Medicaid |
$122.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$207.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$149.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$124.90
|
| Rate for Payer: Molina Healthcare Passport |
$122.45
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$194.81
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$149.85
|
|
|
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
|
Facility
|
OP
|
$1,916.14
|
|
|
Service Code
|
CPT 69436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,368.67 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
|
|
TYMPANOSTOMY(T
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
HCPCS 69436
|
| Hospital Charge Code |
761T2421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,280.00 |
| 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 |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,903.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| 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 |
$1,368.67
|
| 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 |
$1,642.40
|
| 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 |
$2,977.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,568.18
|
| Rate for Payer: PHCS Commercial |
$3,573.12
|
| Rate for Payer: United Healthcare All Payer |
$3,275.36
|
|
|
TYMPANOSTOMY(T
|
Facility
|
IP
|
$3,722.00
|
|
|
Service Code
|
HCPCS 69436
|
| Hospital Charge Code |
761T2421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,116.60 |
| 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 |
$2,977.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,568.18
|
| Rate for Payer: PHCS Commercial |
$3,573.12
|
| Rate for Payer: United Healthcare All Payer |
$3,275.36
|
|
|
TYMPANOSTOMY W/TUB INSERTION
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
76102420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$2,088.00 |
| Rate for Payer: Aetna Commercial |
$1,674.75
|
| Rate for Payer: Anthem Medicaid |
$747.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,696.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$1,087.50
|
| Rate for Payer: Cash Price |
$1,087.50
|
| Rate for Payer: Cigna Commercial |
$1,805.25
|
| Rate for Payer: First Health Commercial |
$2,066.25
|
| Rate for Payer: Humana Commercial |
$1,848.75
|
| Rate for Payer: Humana KY Medicaid |
$747.98
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$755.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,783.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,605.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,914.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,892.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.75
|
| Rate for Payer: PHCS Commercial |
$2,088.00
|
| Rate for Payer: United Healthcare All Payer |
$1,914.00
|
|
|
TYMPANOSTOMY W/TUB INSERTION
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
76102420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$652.50 |
| Max. Negotiated Rate |
$2,088.00 |
| Rate for Payer: Aetna Commercial |
$1,674.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,696.50
|
| Rate for Payer: Cash Price |
$1,087.50
|
| Rate for Payer: Cigna Commercial |
$1,805.25
|
| Rate for Payer: First Health Commercial |
$2,066.25
|
| Rate for Payer: Humana Commercial |
$1,848.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,783.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,605.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,914.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,892.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.75
|
| Rate for Payer: PHCS Commercial |
$2,088.00
|
| Rate for Payer: United Healthcare All Payer |
$1,914.00
|
|
|
TYMPANOSTOMY W/TUB INSERTION
|
Professional
|
Both
|
$2,175.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
76102420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna Commercial |
$184.33
|
| Rate for Payer: Ambetter Exchange |
$124.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.31
|
| Rate for Payer: Anthem Medicaid |
$82.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$148.97
|
| Rate for Payer: Cash Price |
$1,087.50
|
| Rate for Payer: Cash Price |
$1,087.50
|
| Rate for Payer: Cigna Commercial |
$266.62
|
| Rate for Payer: Healthspan PPO |
$240.89
|
| Rate for Payer: Humana Medicaid |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$166.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.10
|
| Rate for Payer: Molina Healthcare Passport |
$82.45
|
| Rate for Payer: Multiplan PHCS |
$1,305.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.38
|
| Rate for Payer: UHCCP Medicaid |
$70.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.14
|
|
|
TYMPANOSTOMY W/TUB INSERTION(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
761P2420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$266.62 |
| Rate for Payer: Aetna Commercial |
$184.33
|
| Rate for Payer: Ambetter Exchange |
$124.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.31
|
| Rate for Payer: Anthem Medicaid |
$82.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$148.97
|
| 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 |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$166.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.10
|
| Rate for Payer: Molina Healthcare Passport |
$82.45
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.38
|
| Rate for Payer: UHCCP Medicaid |
$70.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.14
|
|
|
TYMPANOSTOMY W/TUB INSERTION(T
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
761T2420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
TYMPANOSTOMY W/TUB INSERTION(T
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 69433
|
| Hospital Charge Code |
761T2420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
