|
TRLUML PERIP ATHRC RENAL ART
|
Professional
|
Both
|
$16,997.00
|
|
| Hospital Charge Code |
50000001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,948.95 |
| Max. Negotiated Rate |
$16,997.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$16,997.00
|
| Rate for Payer: Cash Price |
$8,498.50
|
| Rate for Payer: Multiplan PHCS |
$10,198.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11,897.90
|
| Rate for Payer: UHCCP Medicaid |
$5,948.95
|
|
|
TRLUML PERIP ATHRC RENAL ART
|
Professional
|
Both
|
$16,997.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,948.95 |
| Max. Negotiated Rate |
$16,997.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$16,997.00
|
| Rate for Payer: Cash Price |
$8,498.50
|
| Rate for Payer: Multiplan PHCS |
$10,198.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11,897.90
|
| Rate for Payer: UHCCP Medicaid |
$5,948.95
|
|
|
TRLUML PERIP ATHRC RENAL ART
|
Facility
|
IP
|
$16,997.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,209.61 |
| Max. Negotiated Rate |
$16,317.12 |
| Rate for Payer: Aetna Commercial |
$13,087.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,257.66
|
| Rate for Payer: Cash Price |
$8,498.50
|
| Rate for Payer: Cigna Commercial |
$14,107.51
|
| Rate for Payer: First Health Commercial |
$16,147.15
|
| Rate for Payer: Humana Commercial |
$14,447.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,937.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,543.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,099.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,957.36
|
| Rate for Payer: Ohio Health Group HMO |
$12,747.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,399.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,209.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,269.07
|
| Rate for Payer: PHCS Commercial |
$16,317.12
|
| Rate for Payer: United Healthcare All Payer |
$14,957.36
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
50000002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Professional
|
Both
|
$2,200.00
|
|
| Hospital Charge Code |
50000002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
51000024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
51000024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
50000002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
51000024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
TRLUML PERIP ATHRC VISCERAL(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
510P0024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
|
|
TRNSCND FEM HD 28M TPR MED NCK
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TRNSCND FEM HD 28M TPR MED NCK
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TRNSCND FEM HD 28M TPR XLG NCK
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TRNSCND FEM HD 28M TPR XLG NCK
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TRNSCND FEM HD 32M TPR MED NCK
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TRNSCND FEM HD 32M TPR MED NCK
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TRNSCND FEM HD 36M TPR MED NCK
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TRNSCND FEM HD 36M TPR MED NCK
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TRNSCND FEM HD 36M TPR XLG NCK
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TRNSCND FEM HD 36M TPR XLG NCK
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TROBRADEX
|
Facility
|
IP
|
$29.21
|
|
|
Service Code
|
NDC 78087601
|
| Hospital Charge Code |
25001604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Aetna Commercial |
$22.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.78
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Cigna Commercial |
$24.24
|
| Rate for Payer: First Health Commercial |
$27.75
|
| Rate for Payer: Humana Commercial |
$24.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.70
|
| Rate for Payer: Ohio Health Group HMO |
$21.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.06
|
| Rate for Payer: PHCS Commercial |
$28.04
|
| Rate for Payer: United Healthcare All Payer |
$25.70
|
|
|
TROBRADEX
|
Facility
|
OP
|
$29.21
|
|
|
Service Code
|
NDC 78087601
|
| Hospital Charge Code |
25001604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Aetna Commercial |
$22.49
|
| Rate for Payer: Anthem Medicaid |
$10.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.78
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Cigna Commercial |
$24.24
|
| Rate for Payer: First Health Commercial |
$27.75
|
| Rate for Payer: Humana Commercial |
$24.83
|
| Rate for Payer: Humana KY Medicaid |
$10.05
|
| Rate for Payer: Kentucky WC Medicaid |
$10.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.70
|
| Rate for Payer: Ohio Health Group HMO |
$21.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.06
|
| Rate for Payer: PHCS Commercial |
$28.04
|
| Rate for Payer: United Healthcare All Payer |
$25.70
|
|
|
TROCAR TIP WIRE 0.9MM 150MM
|
Facility
|
OP
|
$1,984.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.97 |
| Max. Negotiated Rate |
$1,905.03 |
| Rate for Payer: Aetna Commercial |
$1,528.00
|
| Rate for Payer: Anthem Medicaid |
$682.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.84
|
| Rate for Payer: Cash Price |
$992.20
|
| Rate for Payer: Cigna Commercial |
$1,647.06
|
| Rate for Payer: First Health Commercial |
$1,885.19
|
| Rate for Payer: Humana Commercial |
$1,686.75
|
| Rate for Payer: Humana KY Medicaid |
$682.44
|
| Rate for Payer: Kentucky WC Medicaid |
$689.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$696.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,746.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.17
|
| Rate for Payer: PHCS Commercial |
$1,905.03
|
| Rate for Payer: United Healthcare All Payer |
$1,746.28
|
|
|
TROCAR TIP WIRE 0.9MM 150MM
|
Facility
|
IP
|
$1,984.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.97 |
| Max. Negotiated Rate |
$1,905.03 |
| Rate for Payer: Aetna Commercial |
$1,528.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.84
|
| Rate for Payer: Cash Price |
$992.20
|
| Rate for Payer: Cigna Commercial |
$1,647.06
|
| Rate for Payer: First Health Commercial |
$1,885.19
|
| Rate for Payer: Humana Commercial |
$1,686.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,746.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.17
|
| Rate for Payer: PHCS Commercial |
$1,905.03
|
| Rate for Payer: United Healthcare All Payer |
$1,746.28
|
|
|
TROCAR TIPWIRE2X END 1.1 150MM
|
Facility
|
OP
|
$3,235.09
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.56 |
| Max. Negotiated Rate |
$3,105.69 |
| Rate for Payer: Aetna Commercial |
$2,491.02
|
| Rate for Payer: Anthem Medicaid |
$1,112.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,523.37
|
| Rate for Payer: Cash Price |
$1,617.55
|
| Rate for Payer: Cigna Commercial |
$2,685.12
|
| Rate for Payer: First Health Commercial |
$3,073.34
|
| Rate for Payer: Humana Commercial |
$2,749.83
|
| Rate for Payer: Humana KY Medicaid |
$1,112.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,123.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,652.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,387.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$970.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,134.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,846.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,426.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.88
|
| Rate for Payer: PHCS Commercial |
$3,105.69
|
| Rate for Payer: United Healthcare All Payer |
$2,846.88
|
|
