|
TOT HIP BALL 32MM +5
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
TOT HIP BALL 32MM +5
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
TOUCH PUMP 517750
|
Facility
|
OP
|
$27,426.35
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.43 |
| Max. Negotiated Rate |
$26,329.30 |
| Rate for Payer: Aetna Commercial |
$21,118.29
|
| Rate for Payer: Anthem Medicaid |
$9,431.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,392.55
|
| Rate for Payer: Cash Price |
$13,713.17
|
| Rate for Payer: Cigna Commercial |
$22,763.87
|
| Rate for Payer: First Health Commercial |
$26,055.03
|
| Rate for Payer: Humana Commercial |
$23,312.40
|
| Rate for Payer: Humana KY Medicaid |
$9,431.92
|
| Rate for Payer: Kentucky WC Medicaid |
$9,527.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,489.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,240.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,227.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,621.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,135.19
|
| Rate for Payer: Ohio Health Group HMO |
$20,569.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,485.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,502.17
|
| Rate for Payer: PHCS Commercial |
$26,329.30
|
| Rate for Payer: United Healthcare All Payer |
$24,135.19
|
|
|
TOUCH PUMP 517750
|
Facility
|
IP
|
$27,426.35
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.43 |
| Max. Negotiated Rate |
$26,329.30 |
| Rate for Payer: Aetna Commercial |
$21,118.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,392.55
|
| Rate for Payer: Cash Price |
$13,713.17
|
| Rate for Payer: Cigna Commercial |
$22,763.87
|
| Rate for Payer: First Health Commercial |
$26,055.03
|
| Rate for Payer: Humana Commercial |
$23,312.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,489.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,240.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,227.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,135.19
|
| Rate for Payer: Ohio Health Group HMO |
$20,569.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,485.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,502.17
|
| Rate for Payer: PHCS Commercial |
$26,329.30
|
| Rate for Payer: United Healthcare All Payer |
$24,135.19
|
|
|
TOXOPLASMOSIS AB IGG
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
30001214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem Medicaid |
$47.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Humana KY Medicaid |
$47.46
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Kentucky WC Medicaid |
$47.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.78
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
TOXOPLASMOSIS AB IGG
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
30001214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.81
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.78
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
T-PLATE 6H
|
Facility
|
IP
|
$5,035.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.55 |
| Max. Negotiated Rate |
$4,833.60 |
| Rate for Payer: Aetna Commercial |
$3,876.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.30
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cigna Commercial |
$4,179.05
|
| Rate for Payer: First Health Commercial |
$4,783.25
|
| Rate for Payer: Humana Commercial |
$4,279.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,128.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,715.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,430.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,560.85
|
| Rate for Payer: PHCS Commercial |
$4,833.60
|
| Rate for Payer: United Healthcare All Payer |
$4,430.80
|
|
|
T-PLATE 6H
|
Facility
|
OP
|
$5,035.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.55 |
| Max. Negotiated Rate |
$4,833.60 |
| Rate for Payer: Aetna Commercial |
$3,876.95
|
| Rate for Payer: Anthem Medicaid |
$1,731.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.30
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cigna Commercial |
$4,179.05
|
| Rate for Payer: First Health Commercial |
$4,783.25
|
| Rate for Payer: Humana Commercial |
$4,279.75
|
| Rate for Payer: Humana KY Medicaid |
$1,731.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,749.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,128.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,715.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,766.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,430.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,560.85
|
| Rate for Payer: PHCS Commercial |
$4,833.60
|
| Rate for Payer: United Healthcare All Payer |
$4,430.80
|
|
|
T-PLATE 7H
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
T-PLATE 7H
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
T-PLATE 8H
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$736.45 |
| Max. Negotiated Rate |
$5,438.40 |
| Rate for Payer: Aetna Commercial |
$4,362.05
|
| Rate for Payer: Anthem Medicaid |
$1,948.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.70
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Cigna Commercial |
$4,701.95
|
| Rate for Payer: First Health Commercial |
$5,381.75
|
| Rate for Payer: Humana Commercial |
$4,815.25
|
| Rate for Payer: Humana KY Medicaid |
$1,948.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,987.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,756.15
|
| Rate for Payer: PHCS Commercial |
$5,438.40
|
| Rate for Payer: United Healthcare All Payer |
$4,985.20
|
|
|
T-PLATE 8H
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$736.45 |
| Max. Negotiated Rate |
$5,438.40 |
| Rate for Payer: Aetna Commercial |
$4,362.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.70
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Cigna Commercial |
$4,701.95
|
| Rate for Payer: First Health Commercial |
$5,381.75
|
| Rate for Payer: Humana Commercial |
$4,815.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,756.15
|
| Rate for Payer: PHCS Commercial |
$5,438.40
|
| Rate for Payer: United Healthcare All Payer |
$4,985.20
|
|
|
TPO ANTIBODIES
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
TPO ANTIBODIES
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$25.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$120.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$12.95
|
| Rate for Payer: Healthspan PPO |
$15.25
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.00
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
|
|
TPO ANTIBODIES
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
30001091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$41.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Humana KY Medicaid |
$41.27
|
| Rate for Payer: Humana Medicare Advantage |
$14.55
|
| Rate for Payer: Kentucky WC Medicaid |
$41.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
TPRNL PLMT BIODEGRDABL MATRL
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 55874
|
| Hospital Charge Code |
76102949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.33 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.39
|
| Rate for Payer: Anthem Medicaid |
$133.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$388.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$276.89
|
| Rate for Payer: Humana Medicaid |
$133.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.00
|
| Rate for Payer: Molina Healthcare Passport |
$133.33
|
| Rate for Payer: Multiplan PHCS |
$232.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$271.60
|
| Rate for Payer: UHCCP Medicaid |
$141.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.66
|
|
|
TPRNL PLMT BIODEGRDABL MATRL
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 55874
|
| Hospital Charge Code |
76102949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.28
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
TPRNL PLMT BIODEGRDABL MATRL
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 55874
|
| Hospital Charge Code |
76102949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Humana KY Medicaid |
$133.43
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$134.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.28
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
TRABEX+ HANDPIECE
|
Facility
|
OP
|
$4,121.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.80 |
| Max. Negotiated Rate |
$3,956.64 |
| Rate for Payer: Aetna Commercial |
$3,173.56
|
| Rate for Payer: Anthem Medicaid |
$1,417.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,214.77
|
| Rate for Payer: Cash Price |
$2,060.75
|
| Rate for Payer: Cigna Commercial |
$3,420.84
|
| Rate for Payer: First Health Commercial |
$3,915.42
|
| Rate for Payer: Humana Commercial |
$3,503.28
|
| Rate for Payer: Humana KY Medicaid |
$1,417.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,431.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,379.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,041.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,236.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,445.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,626.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,091.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.66
|
| Rate for Payer: PHCS Commercial |
$3,956.64
|
| Rate for Payer: United Healthcare All Payer |
$3,626.92
|
|
|
TRABEX+ HANDPIECE
|
Facility
|
IP
|
$4,121.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.80 |
| Max. Negotiated Rate |
$3,956.64 |
| Rate for Payer: Aetna Commercial |
$3,173.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,214.77
|
| Rate for Payer: Cash Price |
$2,060.75
|
| Rate for Payer: Cigna Commercial |
$3,420.84
|
| Rate for Payer: First Health Commercial |
$3,915.42
|
| Rate for Payer: Humana Commercial |
$3,503.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,379.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,041.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,236.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,626.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,091.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.66
|
| Rate for Payer: PHCS Commercial |
$3,956.64
|
| Rate for Payer: United Healthcare All Payer |
$3,626.92
|
|
|
TRAB METAL REVISION SHELL 48MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB METAL REVISION SHELL 48MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MET FEM CONE AGT LG 30M L
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT LG 30M L
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT LG 30M R
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
