|
TROCAR TIPWIRE2X END 1.1 150MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
TROCAR TIPWIRE2X END 1.6 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 TIPWIRE2X END 1.6 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 2.0 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 2.0 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 TI WIRE 2XEND1.25 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 TI WIRE 2XEND1.25 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
|
|
|
TRODELVY 2.5mg (180mg SDV)
|
Facility
|
IP
|
$13,428.58
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
25004424
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,745.72 |
| Max. Negotiated Rate |
$12,891.44 |
| Rate for Payer: Aetna Commercial |
$10,340.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,474.29
|
| Rate for Payer: Cash Price |
$6,714.29
|
| Rate for Payer: Cigna Commercial |
$11,145.72
|
| Rate for Payer: First Health Commercial |
$12,757.15
|
| Rate for Payer: Humana Commercial |
$11,414.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,011.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,910.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,028.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,817.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,071.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,685.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,745.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,162.86
|
| Rate for Payer: PHCS Commercial |
$12,891.44
|
| Rate for Payer: United Healthcare All Payer |
$11,817.15
|
|
|
TRODELVY 2.5mg (180mg SDV)
|
Facility
|
OP
|
$13,428.58
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
25004424
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$12,891.44 |
| Rate for Payer: Aetna Commercial |
$10,340.01
|
| Rate for Payer: Anthem Medicaid |
$4,618.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,474.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$47.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.00
|
| Rate for Payer: Cash Price |
$6,714.29
|
| Rate for Payer: Cash Price |
$6,714.29
|
| Rate for Payer: Cigna Commercial |
$11,145.72
|
| Rate for Payer: First Health Commercial |
$12,757.15
|
| Rate for Payer: Humana Commercial |
$11,414.29
|
| Rate for Payer: Humana KY Medicaid |
$4,618.09
|
| Rate for Payer: Humana Medicare Advantage |
$34.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,665.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,011.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,910.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,710.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,817.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,071.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,685.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,745.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,162.86
|
| Rate for Payer: PHCS Commercial |
$12,891.44
|
| Rate for Payer: United Healthcare All Payer |
$11,817.15
|
|
|
TROPHAMINE 10% 500ML Bag
|
Facility
|
OP
|
$195.30
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$187.49 |
| Rate for Payer: Aetna Commercial |
$150.38
|
| Rate for Payer: Anthem Medicaid |
$67.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.33
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna Commercial |
$162.10
|
| Rate for Payer: First Health Commercial |
$185.54
|
| Rate for Payer: Humana Commercial |
$166.00
|
| Rate for Payer: Humana KY Medicaid |
$67.16
|
| Rate for Payer: Kentucky WC Medicaid |
$67.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$160.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$144.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.86
|
| Rate for Payer: Ohio Health Group HMO |
$146.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.54
|
| Rate for Payer: PHCS Commercial |
$187.49
|
| Rate for Payer: United Healthcare All Payer |
$171.86
|
|
|
TROPHAMINE 10% 500ML Bag
|
Facility
|
IP
|
$195.30
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$187.49 |
| Rate for Payer: Aetna Commercial |
$150.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.33
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna Commercial |
$162.10
|
| Rate for Payer: First Health Commercial |
$185.54
|
| Rate for Payer: Humana Commercial |
$166.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$160.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$144.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.86
|
| Rate for Payer: Ohio Health Group HMO |
$146.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.54
|
| Rate for Payer: PHCS Commercial |
$187.49
|
| Rate for Payer: United Healthcare All Payer |
$171.86
|
|
|
TROPONIN, QUANTITATIVE
|
Facility
|
OP
|
$17.46
|
|
|
Service Code
|
CPT 84484
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.47
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.96
|
|
|
TROPONIN- QUANTITATIVE
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
30000545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
TROPONIN- QUANTITATIVE
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
30000545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna Commercial |
$14.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$8.62
|
| Rate for Payer: Healthspan PPO |
$10.31
|
| Rate for Payer: Multiplan PHCS |
$77.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.30
|
| Rate for Payer: UHCCP Medicaid |
$45.15
|
|
|
TROPONIN- QUANTITATIVE
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
30000545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$44.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.47
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$44.36
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: Kentucky WC Medicaid |
$44.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
TRT ANKLE DISLOCTE WO ANESTH
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
76100952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$710.40 |
| Rate for Payer: Aetna Commercial |
$569.80
|
| Rate for Payer: Anthem Medicaid |
$254.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$577.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$614.20
|
| Rate for Payer: First Health Commercial |
$703.00
|
| Rate for Payer: Humana Commercial |
$629.00
|
| Rate for Payer: Humana KY Medicaid |
$254.49
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$257.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$606.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$546.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$259.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$651.20
|
| Rate for Payer: Ohio Health Group HMO |
$555.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.40
|
| Rate for Payer: PHCS Commercial |
$710.40
|
| Rate for Payer: United Healthcare All Payer |
$651.20
|
|
|
TRT ANKLE DISLOCTE WO ANESTH
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
76100952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.56 |
| Max. Negotiated Rate |
$740.00 |
| Rate for Payer: Aetna Commercial |
$494.41
|
| Rate for Payer: Anthem Medicaid |
$180.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$740.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Healthspan PPO |
$447.83
|
| Rate for Payer: Humana Medicaid |
$180.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$436.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.17
|
| Rate for Payer: Molina Healthcare Passport |
$180.56
|
| Rate for Payer: Multiplan PHCS |
$444.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$518.00
|
| Rate for Payer: UHCCP Medicaid |
$259.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.37
|
|
|
TRT ANKLE DISLOCTE WO ANESTH
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
45000171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
TRT ANKLE DISLOCTE WO ANESTH
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
45000171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem Medicaid |
$110.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Humana KY Medicaid |
$110.74
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$111.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
TRT ANKLE DISLOCTE WO ANESTH
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
76100952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$710.40 |
| Rate for Payer: Aetna Commercial |
$569.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$577.20
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$614.20
|
| Rate for Payer: First Health Commercial |
$703.00
|
| Rate for Payer: Humana Commercial |
$629.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$606.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$546.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$651.20
|
| Rate for Payer: Ohio Health Group HMO |
$555.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.40
|
| Rate for Payer: PHCS Commercial |
$710.40
|
| Rate for Payer: United Healthcare All Payer |
$651.20
|
|
|
TRT ANKLE DISLOCTE WO ANESTH(P
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
761P0952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.56 |
| Max. Negotiated Rate |
$740.00 |
| Rate for Payer: Aetna Commercial |
$494.41
|
| Rate for Payer: Anthem Medicaid |
$180.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$740.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Healthspan PPO |
$447.83
|
| Rate for Payer: Humana Medicaid |
$180.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$436.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.17
|
| Rate for Payer: Molina Healthcare Passport |
$180.56
|
| Rate for Payer: Multiplan PHCS |
$444.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$518.00
|
| Rate for Payer: UHCCP Medicaid |
$259.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.37
|
|
|
TRTHLN CR TIB INSRT X3 #1-13M
|
Facility
|
IP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
|
TRTHLN CR TIB INSRT X3 #1-13M
|
Facility
|
OP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem Medicaid |
$3,084.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Humana KY Medicaid |
$3,084.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,115.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,146.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
|
TRTHLN CR TIB INSRT X3 #1-16M
|
Facility
|
OP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem Medicaid |
$3,084.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Humana KY Medicaid |
$3,084.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,115.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,146.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
|
TRTHLN CR TIB INSRT X3 #1-16M
|
Facility
|
IP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
