|
TRIAMCINOLONE 0.025% CRM 80 GM
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
NDC 45802006335
|
| Hospital Charge Code |
25001588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem Medicaid |
$1.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Humana KY Medicaid |
$1.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.42
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
TRIAMCINOLONE 0.1% CREAM 1LB
|
Facility
|
IP
|
$3.51
|
|
|
Service Code
|
NDC 33342032915
|
| Hospital Charge Code |
25001590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.42
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
TRIAMCINOLONE 0.1% CREAM 1LB
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
NDC 33342032915
|
| Hospital Charge Code |
25001590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem Medicaid |
$1.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Humana KY Medicaid |
$1.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.42
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
TRIAMCINOLONE 0.1% CREAM(30GM)
|
Facility
|
OP
|
$2.71
|
|
|
Service Code
|
NDC 51672128202
|
| Hospital Charge Code |
25003534
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Anthem Medicaid |
$0.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.11
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.25
|
| Rate for Payer: First Health Commercial |
$2.57
|
| Rate for Payer: Humana Commercial |
$2.30
|
| Rate for Payer: Humana KY Medicaid |
$0.93
|
| Rate for Payer: Kentucky WC Medicaid |
$0.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.38
|
| Rate for Payer: Ohio Health Group HMO |
$2.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.87
|
| Rate for Payer: PHCS Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Payer |
$2.38
|
|
|
TRIAMCINOLONE 0.1% CREAM(30GM)
|
Facility
|
IP
|
$2.71
|
|
|
Service Code
|
NDC 51672128202
|
| Hospital Charge Code |
25003534
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.11
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.25
|
| Rate for Payer: First Health Commercial |
$2.57
|
| Rate for Payer: Humana Commercial |
$2.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.38
|
| Rate for Payer: Ohio Health Group HMO |
$2.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.87
|
| Rate for Payer: PHCS Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Payer |
$2.38
|
|
|
TRIAMCINOLONE 0.1% CREAM 80GM
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 168000480
|
| Hospital Charge Code |
25001589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna Commercial |
$0.32
|
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Anthem Medicaid |
$0.14
|
| Rate for Payer: Anthem Medicaid |
$0.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: Cigna Commercial |
$0.35
|
| Rate for Payer: First Health Commercial |
$0.98
|
| Rate for Payer: First Health Commercial |
$0.40
|
| Rate for Payer: Humana Commercial |
$0.36
|
| Rate for Payer: Humana Commercial |
$0.88
|
| Rate for Payer: Humana KY Medicaid |
$0.14
|
| Rate for Payer: Humana KY Medicaid |
$0.35
|
| Rate for Payer: Kentucky WC Medicaid |
$0.36
|
| Rate for Payer: Kentucky WC Medicaid |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.91
|
| Rate for Payer: Ohio Health Group HMO |
$0.32
|
| Rate for Payer: Ohio Health Group HMO |
$0.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.71
|
| Rate for Payer: PHCS Commercial |
$0.99
|
| Rate for Payer: PHCS Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Payer |
$0.91
|
| Rate for Payer: United Healthcare All Payer |
$0.37
|
|
|
TRIAMCINOLONE 0.1% CREAM 80GM
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 168000480
|
| Hospital Charge Code |
25001589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna Commercial |
$0.32
|
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna Commercial |
$0.35
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: First Health Commercial |
$0.98
|
| Rate for Payer: First Health Commercial |
$0.40
|
| Rate for Payer: Humana Commercial |
$0.88
|
| Rate for Payer: Humana Commercial |
$0.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.91
|
| Rate for Payer: Ohio Health Group HMO |
$0.32
|
| Rate for Payer: Ohio Health Group HMO |
$0.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.29
|
| Rate for Payer: PHCS Commercial |
$0.40
|
| Rate for Payer: PHCS Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Payer |
$0.37
|
| Rate for Payer: United Healthcare All Payer |
$0.91
|
|
|
TRIAMCINOLONE 0.1% OINT 80GM
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 168000680
|
| Hospital Charge Code |
25001591
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.83
|
| Rate for Payer: Anthem Medicaid |
$0.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.84
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna Commercial |
$0.90
|
| Rate for Payer: First Health Commercial |
$1.03
|
| Rate for Payer: Humana Commercial |
$0.92
|
| Rate for Payer: Humana KY Medicaid |
$0.37
|
| Rate for Payer: Kentucky WC Medicaid |
$0.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.95
|
| Rate for Payer: Ohio Health Group HMO |
$0.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.75
|
| Rate for Payer: PHCS Commercial |
$1.04
|
| Rate for Payer: United Healthcare All Payer |
$0.95
|
|
|
TRIAMCINOLONE 0.1% OINT 80GM
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 168000680
|
| Hospital Charge Code |
25001591
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.84
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna Commercial |
$0.90
|
| Rate for Payer: First Health Commercial |
$1.03
|
| Rate for Payer: Humana Commercial |
$0.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.95
|
| Rate for Payer: Ohio Health Group HMO |
$0.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.75
|
| Rate for Payer: PHCS Commercial |
$1.04
|
| Rate for Payer: United Healthcare All Payer |
$0.95
|
|
|
TRIAMCINOLONE 0.5% OINT (15GM)
|
Facility
|
OP
|
$5.55
|
|
|
Service Code
|
NDC 45802004935
|
| Hospital Charge Code |
25003536
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$5.33 |
| Rate for Payer: Aetna Commercial |
$4.27
|
| Rate for Payer: Anthem Medicaid |
$1.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.33
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: First Health Commercial |
$5.27
|
| Rate for Payer: Humana Commercial |
$4.72
|
| Rate for Payer: Humana KY Medicaid |
$1.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.88
|
| Rate for Payer: Ohio Health Group HMO |
$4.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.83
|
| Rate for Payer: PHCS Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Payer |
$4.88
|
|
|
TRIAMCINOLONE 0.5% OINT (15GM)
|
Facility
|
IP
|
$5.55
|
|
|
Service Code
|
NDC 45802004935
|
| Hospital Charge Code |
25003536
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$5.33 |
| Rate for Payer: Aetna Commercial |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.33
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: First Health Commercial |
$5.27
|
| Rate for Payer: Humana Commercial |
$4.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.88
|
| Rate for Payer: Ohio Health Group HMO |
$4.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.83
|
| Rate for Payer: PHCS Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Payer |
$4.88
|
|
|
TRIATH HINGE BUSH/AXLE
|
Facility
|
IP
|
$13,909.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,172.99 |
| Max. Negotiated Rate |
$13,353.56 |
| Rate for Payer: Aetna Commercial |
$10,710.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,849.77
|
| Rate for Payer: Cash Price |
$6,954.98
|
| Rate for Payer: Cigna Commercial |
$11,545.27
|
| Rate for Payer: First Health Commercial |
$13,214.46
|
| Rate for Payer: Humana Commercial |
$11,823.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,406.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,265.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,172.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,240.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,432.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,127.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,101.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,597.87
|
| Rate for Payer: PHCS Commercial |
$13,353.56
|
| Rate for Payer: United Healthcare All Payer |
$12,240.76
|
|
|
TRIATH HINGE BUSH/AXLE
|
Facility
|
OP
|
$13,909.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,172.99 |
| Max. Negotiated Rate |
$13,353.56 |
| Rate for Payer: Aetna Commercial |
$10,710.67
|
| Rate for Payer: Anthem Medicaid |
$4,783.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,849.77
|
| Rate for Payer: Cash Price |
$6,954.98
|
| Rate for Payer: Cigna Commercial |
$11,545.27
|
| Rate for Payer: First Health Commercial |
$13,214.46
|
| Rate for Payer: Humana Commercial |
$11,823.47
|
| Rate for Payer: Humana KY Medicaid |
$4,783.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,832.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,406.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,265.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,172.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,879.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,240.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,432.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,127.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,101.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,597.87
|
| Rate for Payer: PHCS Commercial |
$13,353.56
|
| Rate for Payer: United Healthcare All Payer |
$12,240.76
|
|
|
TRIATH HINGE TIB BEARING
|
Facility
|
IP
|
$26,324.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,897.31 |
| Max. Negotiated Rate |
$25,271.40 |
| Rate for Payer: Aetna Commercial |
$20,269.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,533.02
|
| Rate for Payer: Cash Price |
$13,162.19
|
| Rate for Payer: Cigna Commercial |
$21,849.24
|
| Rate for Payer: First Health Commercial |
$25,008.16
|
| Rate for Payer: Humana Commercial |
$22,375.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,585.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,427.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,897.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,165.45
|
| Rate for Payer: Ohio Health Group HMO |
$19,743.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,059.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,902.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,163.82
|
| Rate for Payer: PHCS Commercial |
$25,271.40
|
| Rate for Payer: United Healthcare All Payer |
$23,165.45
|
|
|
TRIATH HINGE TIB BEARING
|
Facility
|
OP
|
$26,324.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,897.31 |
| Max. Negotiated Rate |
$25,271.40 |
| Rate for Payer: Aetna Commercial |
$20,269.77
|
| Rate for Payer: Anthem Medicaid |
$9,052.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,533.02
|
| Rate for Payer: Cash Price |
$13,162.19
|
| Rate for Payer: Cigna Commercial |
$21,849.24
|
| Rate for Payer: First Health Commercial |
$25,008.16
|
| Rate for Payer: Humana Commercial |
$22,375.72
|
| Rate for Payer: Humana KY Medicaid |
$9,052.95
|
| Rate for Payer: Kentucky WC Medicaid |
$9,145.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,585.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,427.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,897.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,234.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,165.45
|
| Rate for Payer: Ohio Health Group HMO |
$19,743.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,059.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,902.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,163.82
|
| Rate for Payer: PHCS Commercial |
$25,271.40
|
| Rate for Payer: United Healthcare All Payer |
$23,165.45
|
|
|
TRIATHION PATELLA A38*11MM
|
Facility
|
IP
|
$4,896.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.02 |
| Max. Negotiated Rate |
$4,700.86 |
| Rate for Payer: Aetna Commercial |
$3,770.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.45
|
| Rate for Payer: Cash Price |
$2,448.36
|
| Rate for Payer: Cigna Commercial |
$4,064.29
|
| Rate for Payer: First Health Commercial |
$4,651.89
|
| Rate for Payer: Humana Commercial |
$4,162.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.74
|
| Rate for Payer: PHCS Commercial |
$4,700.86
|
| Rate for Payer: United Healthcare All Payer |
$4,309.12
|
|
|
TRIATHION PATELLA A38*11MM
|
Facility
|
OP
|
$4,896.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.02 |
| Max. Negotiated Rate |
$4,700.86 |
| Rate for Payer: Aetna Commercial |
$3,770.48
|
| Rate for Payer: Anthem Medicaid |
$1,683.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.45
|
| Rate for Payer: Cash Price |
$2,448.36
|
| Rate for Payer: Cigna Commercial |
$4,064.29
|
| Rate for Payer: First Health Commercial |
$4,651.89
|
| Rate for Payer: Humana Commercial |
$4,162.22
|
| Rate for Payer: Humana KY Medicaid |
$1,683.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,701.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.74
|
| Rate for Payer: PHCS Commercial |
$4,700.86
|
| Rate for Payer: United Healthcare All Payer |
$4,309.12
|
|
|
TRIATHLN CR TIB INSRT X3 #1-9M
|
Facility
|
OP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIATHLN CR TIB INSRT X3 #1-9M
|
Facility
|
IP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIATHLN CR TIB INSRT X3 #8-9M
|
Facility
|
IP
|
$9,168.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.55 |
| Max. Negotiated Rate |
$8,801.76 |
| Rate for Payer: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
|
|
TRIATHLN CR TIB INSRT X3 #8-9M
|
Facility
|
OP
|
$9,168.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.55 |
| Max. Negotiated Rate |
$8,801.76 |
| Rate for Payer: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
|
|
TRIATHLN FEM DIS AUG 10MM #1 L
|
Facility
|
IP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #1 L
|
Facility
|
OP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem Medicaid |
$2,775.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Humana KY Medicaid |
$2,775.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,804.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,831.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #1 R
|
Facility
|
IP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #1 R
|
Facility
|
OP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem Medicaid |
$2,775.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Humana KY Medicaid |
$2,775.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,804.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,831.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
