|
TRAILBLAZER 0.035
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
TRAILBLAZER 0.035
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem Medicaid |
$596.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Humana KY Medicaid |
$596.67
|
| Rate for Payer: Kentucky WC Medicaid |
$602.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
TRAILBLAZER .018 ANGLED
|
Facility
|
IP
|
$2,046.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.04 |
| Max. Negotiated Rate |
$1,964.64 |
| Rate for Payer: Aetna Commercial |
$1,575.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,596.27
|
| Rate for Payer: Cash Price |
$1,023.25
|
| Rate for Payer: Cigna Commercial |
$1,698.60
|
| Rate for Payer: First Health Commercial |
$1,944.18
|
| Rate for Payer: Humana Commercial |
$1,739.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,678.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,510.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.42
|
| Rate for Payer: PHCS Commercial |
$1,964.64
|
| Rate for Payer: United Healthcare All Payer |
$1,800.92
|
|
|
TRAILBLAZER .018 ANGLED
|
Facility
|
OP
|
$2,046.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.04 |
| Max. Negotiated Rate |
$1,964.64 |
| Rate for Payer: Aetna Commercial |
$1,575.80
|
| Rate for Payer: Anthem Medicaid |
$703.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,596.27
|
| Rate for Payer: Cash Price |
$1,023.25
|
| Rate for Payer: Cigna Commercial |
$1,698.60
|
| Rate for Payer: First Health Commercial |
$1,944.18
|
| Rate for Payer: Humana Commercial |
$1,739.52
|
| Rate for Payer: Humana KY Medicaid |
$703.79
|
| Rate for Payer: Kentucky WC Medicaid |
$710.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,678.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,510.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$717.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.42
|
| Rate for Payer: PHCS Commercial |
$1,964.64
|
| Rate for Payer: United Healthcare All Payer |
$1,800.92
|
|
|
TRAILBLAZER 0.35 ANGLED
|
Facility
|
OP
|
$5,647.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.18 |
| Max. Negotiated Rate |
$5,421.60 |
| Rate for Payer: Aetna Commercial |
$4,348.58
|
| Rate for Payer: Anthem Medicaid |
$1,942.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,405.05
|
| Rate for Payer: Cash Price |
$2,823.75
|
| Rate for Payer: Cigna Commercial |
$4,687.42
|
| Rate for Payer: First Health Commercial |
$5,365.12
|
| Rate for Payer: Humana Commercial |
$4,800.38
|
| Rate for Payer: Humana KY Medicaid |
$1,942.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,961.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,630.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,167.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,694.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,981.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,969.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,235.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,129.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.72
|
| Rate for Payer: PHCS Commercial |
$5,421.60
|
| Rate for Payer: United Healthcare All Payer |
$4,969.80
|
|
|
TRAILBLAZER 0.35 ANGLED
|
Facility
|
IP
|
$5,647.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.18 |
| Max. Negotiated Rate |
$5,421.60 |
| Rate for Payer: Aetna Commercial |
$4,348.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,405.05
|
| Rate for Payer: Cash Price |
$2,823.75
|
| Rate for Payer: Cigna Commercial |
$4,687.42
|
| Rate for Payer: First Health Commercial |
$5,365.12
|
| Rate for Payer: Humana Commercial |
$4,800.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,630.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,167.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,694.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,969.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,235.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,129.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.72
|
| Rate for Payer: PHCS Commercial |
$5,421.60
|
| Rate for Payer: United Healthcare All Payer |
$4,969.80
|
|
|
TRAINING AND FITTING FOR DEV
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 92609
|
| Hospital Charge Code |
44000012
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.60
|
| 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
|
|
|
TRAINING AND FITTING FOR DEV
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 92609
|
| Hospital Charge Code |
44000012
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$41.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.60
|
| 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: 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 |
$36.00
|
| 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
|
|
|
TRAN BAL ANGIO EA ADDL VIS ART
|
Facility
|
OP
|
$2,474.00
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$321.62 |
| Max. Negotiated Rate |
$2,375.04 |
| Rate for Payer: Aetna Commercial |
$1,904.98
|
| Rate for Payer: Anthem Medicaid |
$850.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,929.72
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$2,053.42
|
| Rate for Payer: First Health Commercial |
$2,350.30
|
| Rate for Payer: Humana Commercial |
$2,102.90
|
| Rate for Payer: Humana KY Medicaid |
$850.81
|
| Rate for Payer: Kentucky WC Medicaid |
$859.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,028.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,825.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$867.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,177.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,855.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$766.94
|
| Rate for Payer: PHCS Commercial |
$2,375.04
|
| Rate for Payer: United Healthcare All Payer |
$2,177.12
|
|
|
TRAN BAL ANGIO EA ADDL VIS ART
|
Facility
|
IP
|
$2,373.00
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
76101569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.49 |
| Max. Negotiated Rate |
$2,278.08 |
| Rate for Payer: Aetna Commercial |
$1,827.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,850.94
|
| Rate for Payer: Cash Price |
$1,186.50
|
| Rate for Payer: Cigna Commercial |
$1,969.59
|
| Rate for Payer: First Health Commercial |
$2,254.35
|
| Rate for Payer: Humana Commercial |
$2,017.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,945.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,751.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$711.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,088.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,779.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$735.63
|
| Rate for Payer: PHCS Commercial |
$2,278.08
|
| Rate for Payer: United Healthcare All Payer |
$2,088.24
|
|
|
TRAN BAL ANGIO EA ADDL VIS ART
|
Facility
|
IP
|
$2,474.00
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$321.62 |
| Max. Negotiated Rate |
$2,375.04 |
| Rate for Payer: Aetna Commercial |
$1,904.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,929.72
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$2,053.42
|
| Rate for Payer: First Health Commercial |
$2,350.30
|
| Rate for Payer: Humana Commercial |
$2,102.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,028.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,825.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,177.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,855.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$766.94
|
| Rate for Payer: PHCS Commercial |
$2,375.04
|
| Rate for Payer: United Healthcare All Payer |
$2,177.12
|
|
|
TRAN BAL ANGIO EA ADDL VIS ART
|
Facility
|
OP
|
$2,373.00
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
76101569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.49 |
| Max. Negotiated Rate |
$2,278.08 |
| Rate for Payer: Aetna Commercial |
$1,827.21
|
| Rate for Payer: Anthem Medicaid |
$816.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,850.94
|
| Rate for Payer: Cash Price |
$1,186.50
|
| Rate for Payer: Cigna Commercial |
$1,969.59
|
| Rate for Payer: First Health Commercial |
$2,254.35
|
| Rate for Payer: Humana Commercial |
$2,017.05
|
| Rate for Payer: Humana KY Medicaid |
$816.07
|
| Rate for Payer: Kentucky WC Medicaid |
$824.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,945.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,751.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$711.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$832.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,088.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,779.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$735.63
|
| Rate for Payer: PHCS Commercial |
$2,278.08
|
| Rate for Payer: United Healthcare All Payer |
$2,088.24
|
|
|
TRAN BAL ANGIO EA ADDL VIS ART
|
Facility
|
IP
|
$2,474.00
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
32000369
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$321.62 |
| Max. Negotiated Rate |
$2,375.04 |
| Rate for Payer: Aetna Commercial |
$1,904.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,929.72
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$2,053.42
|
| Rate for Payer: First Health Commercial |
$2,350.30
|
| Rate for Payer: Humana Commercial |
$2,102.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,028.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,825.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,177.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,855.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$766.94
|
| Rate for Payer: PHCS Commercial |
$2,375.04
|
| Rate for Payer: United Healthcare All Payer |
$2,177.12
|
|
|
TRAN BAL ANGIO EA ADDL VIS ART
|
Facility
|
OP
|
$2,474.00
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
32000369
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$321.62 |
| Max. Negotiated Rate |
$2,375.04 |
| Rate for Payer: Aetna Commercial |
$1,904.98
|
| Rate for Payer: Anthem Medicaid |
$850.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,929.72
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$2,053.42
|
| Rate for Payer: First Health Commercial |
$2,350.30
|
| Rate for Payer: Humana Commercial |
$2,102.90
|
| Rate for Payer: Humana KY Medicaid |
$850.81
|
| Rate for Payer: Kentucky WC Medicaid |
$859.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,028.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,825.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$867.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,177.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,855.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$766.94
|
| Rate for Payer: PHCS Commercial |
$2,375.04
|
| Rate for Payer: United Healthcare All Payer |
$2,177.12
|
|
|
TRAN BAL ANGIO RENAL/VISE ARTE
|
Facility
|
IP
|
$7,272.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$945.36 |
| Max. Negotiated Rate |
$6,981.12 |
| Rate for Payer: Aetna Commercial |
$5,599.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,672.16
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cigna Commercial |
$6,035.76
|
| Rate for Payer: First Health Commercial |
$6,908.40
|
| Rate for Payer: Humana Commercial |
$6,181.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,963.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,366.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,181.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,399.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,454.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,254.32
|
| Rate for Payer: PHCS Commercial |
$6,981.12
|
| Rate for Payer: United Healthcare All Payer |
$6,399.36
|
|
|
TRAN BAL ANGIO RENAL/VISE ARTE
|
Facility
|
IP
|
$4,600.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
76101568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.00 |
| Max. Negotiated Rate |
$4,416.00 |
| Rate for Payer: Aetna Commercial |
$3,542.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cigna Commercial |
$3,818.00
|
| Rate for Payer: First Health Commercial |
$4,370.00
|
| Rate for Payer: Humana Commercial |
$3,910.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,394.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.00
|
| Rate for Payer: PHCS Commercial |
$4,416.00
|
| Rate for Payer: United Healthcare All Payer |
$4,048.00
|
|
|
TRAN BAL ANGIO RENAL/VISE ARTE
|
Professional
|
Both
|
$4,600.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
761P1568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.48 |
| Max. Negotiated Rate |
$4,600.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$290.48
|
| Rate for Payer: Anthem Medicaid |
$290.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,600.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cigna Commercial |
$652.50
|
| Rate for Payer: Humana Medicaid |
$290.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$461.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.55
|
| Rate for Payer: Molina Healthcare Passport |
$290.74
|
| Rate for Payer: Multiplan PHCS |
$2,760.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,220.00
|
| Rate for Payer: UHCCP Medicaid |
$305.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.65
|
|
|
TRAN BAL ANGIO RENAL/VISE ARTE
|
Professional
|
Both
|
$4,600.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
76101568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.48 |
| Max. Negotiated Rate |
$4,600.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$290.48
|
| Rate for Payer: Anthem Medicaid |
$290.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,600.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cigna Commercial |
$652.50
|
| Rate for Payer: Humana Medicaid |
$290.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$461.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.55
|
| Rate for Payer: Molina Healthcare Passport |
$290.74
|
| Rate for Payer: Multiplan PHCS |
$2,760.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,220.00
|
| Rate for Payer: UHCCP Medicaid |
$305.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.65
|
|
|
TRAN BAL ANGIO RENAL/VISE ARTE
|
Facility
|
OP
|
$7,272.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
32000368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$945.36 |
| Max. Negotiated Rate |
$6,981.12 |
| Rate for Payer: Aetna Commercial |
$5,599.44
|
| Rate for Payer: Anthem Medicaid |
$2,500.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,672.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cigna Commercial |
$6,035.76
|
| Rate for Payer: First Health Commercial |
$6,908.40
|
| Rate for Payer: Humana Commercial |
$6,181.20
|
| Rate for Payer: Humana KY Medicaid |
$2,500.84
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,526.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,963.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,366.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,551.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,399.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,454.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,254.32
|
| Rate for Payer: PHCS Commercial |
$6,981.12
|
| Rate for Payer: United Healthcare All Payer |
$6,399.36
|
|
|
TRAN BAL ANGIO RENAL/VISE ARTE
|
Facility
|
IP
|
$7,272.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
32000368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$945.36 |
| Max. Negotiated Rate |
$6,981.12 |
| Rate for Payer: Aetna Commercial |
$5,599.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,672.16
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cigna Commercial |
$6,035.76
|
| Rate for Payer: First Health Commercial |
$6,908.40
|
| Rate for Payer: Humana Commercial |
$6,181.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,963.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,366.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,181.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,399.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,454.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,254.32
|
| Rate for Payer: PHCS Commercial |
$6,981.12
|
| Rate for Payer: United Healthcare All Payer |
$6,399.36
|
|
|
TRAN BAL ANGIO RENAL/VISE ARTE
|
Facility
|
OP
|
$4,600.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
76101568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.00 |
| Max. Negotiated Rate |
$6,919.70 |
| Rate for Payer: Aetna Commercial |
$3,542.00
|
| Rate for Payer: Anthem Medicaid |
$1,581.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cigna Commercial |
$3,818.00
|
| Rate for Payer: First Health Commercial |
$4,370.00
|
| Rate for Payer: Humana Commercial |
$3,910.00
|
| Rate for Payer: Humana KY Medicaid |
$1,581.94
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,598.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,394.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,613.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.00
|
| Rate for Payer: PHCS Commercial |
$4,416.00
|
| Rate for Payer: United Healthcare All Payer |
$4,048.00
|
|
|
TRAN BAL ANGIO RENAL/VISE ARTE
|
Facility
|
OP
|
$7,272.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$945.36 |
| Max. Negotiated Rate |
$6,981.12 |
| Rate for Payer: Aetna Commercial |
$5,599.44
|
| Rate for Payer: Anthem Medicaid |
$2,500.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,672.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cigna Commercial |
$6,035.76
|
| Rate for Payer: First Health Commercial |
$6,908.40
|
| Rate for Payer: Humana Commercial |
$6,181.20
|
| Rate for Payer: Humana KY Medicaid |
$2,500.84
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,526.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,963.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,366.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,551.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,399.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,454.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,254.32
|
| Rate for Payer: PHCS Commercial |
$6,981.12
|
| Rate for Payer: United Healthcare All Payer |
$6,399.36
|
|
|
TRANEXAMIC ACID 650 MG TABLET
|
Facility
|
OP
|
$12.18
|
|
|
Service Code
|
NDC 591372030
|
| Hospital Charge Code |
25003532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$11.69 |
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: Anthem Medicaid |
$4.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.50
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Cigna Commercial |
$10.11
|
| Rate for Payer: First Health Commercial |
$11.57
|
| Rate for Payer: Humana Commercial |
$10.35
|
| Rate for Payer: Humana KY Medicaid |
$4.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.72
|
| Rate for Payer: Ohio Health Group HMO |
$9.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.78
|
| Rate for Payer: PHCS Commercial |
$11.69
|
| Rate for Payer: United Healthcare All Payer |
$10.72
|
|
|
TRANEXAMIC ACID 650 MG TABLET
|
Facility
|
IP
|
$12.18
|
|
|
Service Code
|
NDC 591372030
|
| Hospital Charge Code |
25003532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$11.69 |
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.50
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Cigna Commercial |
$10.11
|
| Rate for Payer: First Health Commercial |
$11.57
|
| Rate for Payer: Humana Commercial |
$10.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.72
|
| Rate for Payer: Ohio Health Group HMO |
$9.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.78
|
| Rate for Payer: PHCS Commercial |
$11.69
|
| Rate for Payer: United Healthcare All Payer |
$10.72
|
|
|
TRANEXAMIC ACID KIT
|
Facility
|
OP
|
$184.13
|
|
|
Service Code
|
NDC 39822100001
|
| Hospital Charge Code |
25003533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$176.76 |
| Rate for Payer: Aetna Commercial |
$141.78
|
| Rate for Payer: Anthem Medicaid |
$63.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.62
|
| Rate for Payer: Cash Price |
$92.06
|
| Rate for Payer: Cigna Commercial |
$152.83
|
| Rate for Payer: First Health Commercial |
$174.92
|
| Rate for Payer: Humana Commercial |
$156.51
|
| Rate for Payer: Humana KY Medicaid |
$63.32
|
| Rate for Payer: Kentucky WC Medicaid |
$63.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.03
|
| Rate for Payer: Ohio Health Group HMO |
$138.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.08
|
| Rate for Payer: PHCS Commercial |
$176.76
|
| Rate for Payer: United Healthcare All Payer |
$162.03
|
|
