|
TRAILBLAZER .018 ANGLED
|
Facility
|
IP
|
$2,056.20
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$616.86 |
| Max. Negotiated Rate |
$1,973.95 |
| Rate for Payer: Aetna Commercial |
$1,583.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.84
|
| Rate for Payer: Cash Price |
$1,028.10
|
| Rate for Payer: Cigna Commercial |
$1,706.65
|
| Rate for Payer: First Health Commercial |
$1,953.39
|
| Rate for Payer: Humana Commercial |
$1,747.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,788.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.78
|
| Rate for Payer: PHCS Commercial |
$1,973.95
|
| Rate for Payer: United Healthcare All Payer |
$1,809.46
|
|
|
TRAILBLAZER .018 ANGLED
|
Facility
|
OP
|
$2,056.20
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$616.86 |
| Max. Negotiated Rate |
$1,973.95 |
| Rate for Payer: Aetna Commercial |
$1,583.27
|
| Rate for Payer: Anthem Medicaid |
$707.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.84
|
| Rate for Payer: Cash Price |
$1,028.10
|
| Rate for Payer: Cigna Commercial |
$1,706.65
|
| Rate for Payer: First Health Commercial |
$1,953.39
|
| Rate for Payer: Humana Commercial |
$1,747.77
|
| Rate for Payer: Humana KY Medicaid |
$707.13
|
| Rate for Payer: Kentucky WC Medicaid |
$714.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,788.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.78
|
| Rate for Payer: PHCS Commercial |
$1,973.95
|
| Rate for Payer: United Healthcare All Payer |
$1,809.46
|
|
|
TRAILBLAZER 0.35 ANGLED
|
Facility
|
OP
|
$5,693.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,708.12 |
| Max. Negotiated Rate |
$5,466.00 |
| Rate for Payer: Aetna Commercial |
$4,384.19
|
| Rate for Payer: Anthem Medicaid |
$1,958.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,441.12
|
| Rate for Payer: Cash Price |
$2,846.88
|
| Rate for Payer: Cigna Commercial |
$4,725.81
|
| Rate for Payer: First Health Commercial |
$5,409.06
|
| Rate for Payer: Humana Commercial |
$4,839.69
|
| Rate for Payer: Humana KY Medicaid |
$1,958.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,978.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,201.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,997.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.69
|
| Rate for Payer: PHCS Commercial |
$5,466.00
|
| Rate for Payer: United Healthcare All Payer |
$5,010.50
|
|
|
TRAILBLAZER 0.35 ANGLED
|
Facility
|
IP
|
$5,693.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,708.12 |
| Max. Negotiated Rate |
$5,466.00 |
| Rate for Payer: Aetna Commercial |
$4,384.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,441.12
|
| Rate for Payer: Cash Price |
$2,846.88
|
| Rate for Payer: Cigna Commercial |
$4,725.81
|
| Rate for Payer: First Health Commercial |
$5,409.06
|
| Rate for Payer: Humana Commercial |
$4,839.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,201.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.69
|
| Rate for Payer: PHCS Commercial |
$5,466.00
|
| Rate for Payer: United Healthcare All Payer |
$5,010.50
|
|
|
TRAINING AND FITTING FOR DEV
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 92609
|
| Hospital Charge Code |
44000012
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
TRAINING AND FITTING FOR DEV
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 92609
|
| Hospital Charge Code |
44000012
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$42.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Humana KY Medicaid |
$42.30
|
| Rate for Payer: Kentucky WC Medicaid |
$42.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
TRAN BAL ANGIO EA ADDL VIS ART
|
Professional
|
Both
|
$2,474.00
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
76101569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.05 |
| Max. Negotiated Rate |
$1,484.40 |
| Rate for Payer: Ambetter Exchange |
$162.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$144.05
|
| Rate for Payer: Anthem Medicaid |
$648.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$162.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$162.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.06
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$323.54
|
| Rate for Payer: Humana Medicaid |
$648.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$228.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$162.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$661.93
|
| Rate for Payer: Molina Healthcare Passport |
$648.95
|
| Rate for Payer: Multiplan PHCS |
$1,484.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$211.31
|
| Rate for Payer: UHCCP Medicaid |
$151.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$655.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$162.55
|
|
|
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 |
$742.20 |
| 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 |
$1,979.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,152.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.06
|
| 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 |
$742.20 |
| 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 |
$1,979.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,152.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.06
|
| 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
|
$2,474.00
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
32000369
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$742.20 |
| 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 |
$1,979.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,152.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.06
|
| 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
|
$2,474.00
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$742.20 |
| 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 |
$1,979.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,152.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.06
|
| Rate for Payer: PHCS Commercial |
$2,375.04
|
| Rate for Payer: United Healthcare All Payer |
$2,177.12
|
|
|
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 |
$2,760.00 |
| Rate for Payer: Ambetter Exchange |
$326.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$290.48
|
| Rate for Payer: Anthem Medicaid |
$1,598.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$326.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$326.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$391.21
|
| 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 |
$1,598.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$461.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$326.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,630.32
|
| Rate for Payer: Molina Healthcare Passport |
$1,598.35
|
| Rate for Payer: Multiplan PHCS |
$2,760.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$423.81
|
| Rate for Payer: UHCCP Medicaid |
$305.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,614.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$326.01
|
|
|
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 |
$2,500.84 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Aetna Commercial |
$5,599.44
|
| Rate for Payer: Anthem Medicaid |
$2,500.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,672.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| 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 |
$5,268.09
|
| 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 |
$6,321.71
|
| 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 |
$5,817.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,326.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,017.68
|
| Rate for Payer: PHCS Commercial |
$6,981.12
|
| Rate for Payer: United Healthcare All Payer |
$6,399.36
|
|
|
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 |
$2,760.00 |
| Rate for Payer: Ambetter Exchange |
$326.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$290.48
|
| Rate for Payer: Anthem Medicaid |
$1,598.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$326.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$326.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$391.21
|
| 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 |
$1,598.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$461.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$326.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,630.32
|
| Rate for Payer: Molina Healthcare Passport |
$1,598.35
|
| Rate for Payer: Multiplan PHCS |
$2,760.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$423.81
|
| Rate for Payer: UHCCP Medicaid |
$305.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,614.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$326.01
|
|
|
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 |
$2,181.60 |
| 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 |
$5,817.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,326.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,017.68
|
| 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 |
$2,181.60 |
| 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 |
$5,817.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,326.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,017.68
|
| 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 |
$1,581.94 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Aetna Commercial |
$3,542.00
|
| Rate for Payer: Anthem Medicaid |
$1,581.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| 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 |
$5,268.09
|
| 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 |
$6,321.71
|
| 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 |
$3,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,174.00
|
| 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
|
IP
|
$4,600.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
76101568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,380.00 |
| 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 |
$3,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,174.00
|
| 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 |
$2,500.84 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Aetna Commercial |
$5,599.44
|
| Rate for Payer: Anthem Medicaid |
$2,500.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,672.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| 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 |
$5,268.09
|
| 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 |
$6,321.71
|
| 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 |
$5,817.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,326.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,017.68
|
| Rate for Payer: PHCS Commercial |
$6,981.12
|
| Rate for Payer: United Healthcare All Payer |
$6,399.36
|
|
|
TRANEXAMIC ACID 1G PREMIX
|
Facility
|
IP
|
$338.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004544
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$101.58 |
| Max. Negotiated Rate |
$325.06 |
| Rate for Payer: Aetna Commercial |
$260.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.11
|
| Rate for Payer: Cash Price |
$169.30
|
| Rate for Payer: Cigna Commercial |
$281.04
|
| Rate for Payer: First Health Commercial |
$321.67
|
| Rate for Payer: Humana Commercial |
$287.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.97
|
| Rate for Payer: Ohio Health Group HMO |
$253.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.63
|
| Rate for Payer: PHCS Commercial |
$325.06
|
| Rate for Payer: United Healthcare All Payer |
$297.97
|
|
|
TRANEXAMIC ACID 1G PREMIX
|
Facility
|
OP
|
$338.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004544
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$101.58 |
| Max. Negotiated Rate |
$325.06 |
| Rate for Payer: Aetna Commercial |
$260.72
|
| Rate for Payer: Anthem Medicaid |
$116.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.11
|
| Rate for Payer: Cash Price |
$169.30
|
| Rate for Payer: Cigna Commercial |
$281.04
|
| Rate for Payer: First Health Commercial |
$321.67
|
| Rate for Payer: Humana Commercial |
$287.81
|
| Rate for Payer: Humana KY Medicaid |
$116.44
|
| Rate for Payer: Kentucky WC Medicaid |
$117.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.97
|
| Rate for Payer: Ohio Health Group HMO |
$253.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.63
|
| Rate for Payer: PHCS Commercial |
$325.06
|
| Rate for Payer: United Healthcare All Payer |
$297.97
|
|
|
TRANEXAMIC ACID 650 MG TABLET
|
Facility
|
OP
|
$12.18
|
|
|
Service Code
|
NDC 591372030
|
| Hospital Charge Code |
25003532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.65 |
| 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 |
$9.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.40
|
| 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 |
$3.65 |
| 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 |
$9.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.40
|
| Rate for Payer: PHCS Commercial |
$11.69
|
| Rate for Payer: United Healthcare All Payer |
$10.72
|
|
|
TRANS 3.5 CATH 5F
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
TRANS 3.5 CATH 5F
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
