|
TRIATHLON X3 TIB INSRT #8 25MM
|
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
|
|
|
TRI BEADED W/PA PATELLA 32MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRI BEADED W/PA PATELLA 32MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRI BEADED W/PA PATELLA 35MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRI BEADED W/PA PATELLA 35MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRI BEADED W/PA PATELLA 38MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRI BEADED W/PA PATELLA 38MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRI BEADED W/PA PATELLA 40MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRI BEADED W/PA PATELLA 40MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRI CEMENTED STEM 12MM*100MM
|
Facility
|
OP
|
$6,946.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,083.97 |
| Max. Negotiated Rate |
$6,668.70 |
| Rate for Payer: Aetna Commercial |
$5,348.85
|
| Rate for Payer: Anthem Medicaid |
$2,388.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.32
|
| Rate for Payer: Cash Price |
$3,473.28
|
| Rate for Payer: Cigna Commercial |
$5,765.64
|
| Rate for Payer: First Health Commercial |
$6,599.23
|
| Rate for Payer: Humana Commercial |
$5,904.58
|
| Rate for Payer: Humana KY Medicaid |
$2,388.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,083.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,436.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,112.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,209.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.13
|
| Rate for Payer: PHCS Commercial |
$6,668.70
|
| Rate for Payer: United Healthcare All Payer |
$6,112.97
|
|
|
TRI CEMENTED STEM 12MM*100MM
|
Facility
|
IP
|
$6,946.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,083.97 |
| Max. Negotiated Rate |
$6,668.70 |
| Rate for Payer: Aetna Commercial |
$5,348.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.32
|
| Rate for Payer: Cash Price |
$3,473.28
|
| Rate for Payer: Cigna Commercial |
$5,765.64
|
| Rate for Payer: First Health Commercial |
$6,599.23
|
| Rate for Payer: Humana Commercial |
$5,904.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,083.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,112.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,209.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.13
|
| Rate for Payer: PHCS Commercial |
$6,668.70
|
| Rate for Payer: United Healthcare All Payer |
$6,112.97
|
|
|
TRI CEMENTED STEM 12MM*50MM
|
Facility
|
IP
|
$6,946.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,083.97 |
| Max. Negotiated Rate |
$6,668.70 |
| Rate for Payer: Aetna Commercial |
$5,348.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.32
|
| Rate for Payer: Cash Price |
$3,473.28
|
| Rate for Payer: Cigna Commercial |
$5,765.64
|
| Rate for Payer: First Health Commercial |
$6,599.23
|
| Rate for Payer: Humana Commercial |
$5,904.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,083.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,112.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,209.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.13
|
| Rate for Payer: PHCS Commercial |
$6,668.70
|
| Rate for Payer: United Healthcare All Payer |
$6,112.97
|
|
|
TRI CEMENTED STEM 12MM*50MM
|
Facility
|
OP
|
$6,946.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,083.97 |
| Max. Negotiated Rate |
$6,668.70 |
| Rate for Payer: Aetna Commercial |
$5,348.85
|
| Rate for Payer: Anthem Medicaid |
$2,388.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.32
|
| Rate for Payer: Cash Price |
$3,473.28
|
| Rate for Payer: Cigna Commercial |
$5,765.64
|
| Rate for Payer: First Health Commercial |
$6,599.23
|
| Rate for Payer: Humana Commercial |
$5,904.58
|
| Rate for Payer: Humana KY Medicaid |
$2,388.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,083.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,436.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,112.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,209.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.13
|
| Rate for Payer: PHCS Commercial |
$6,668.70
|
| Rate for Payer: United Healthcare All Payer |
$6,112.97
|
|
|
TRI CEMENTED STEM 9MM*100MM
|
Facility
|
OP
|
$8,552.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,565.60 |
| Max. Negotiated Rate |
$8,209.93 |
| Rate for Payer: Aetna Commercial |
$6,585.05
|
| Rate for Payer: Anthem Medicaid |
$2,941.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,670.57
|
| Rate for Payer: Cash Price |
$4,276.01
|
| Rate for Payer: Cigna Commercial |
$7,098.17
|
| Rate for Payer: First Health Commercial |
$8,124.41
|
| Rate for Payer: Humana Commercial |
$7,269.21
|
| Rate for Payer: Humana KY Medicaid |
$2,941.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,970.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,012.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,311.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,565.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,000.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,525.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,414.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,841.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,440.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,900.89
|
| Rate for Payer: PHCS Commercial |
$8,209.93
|
| Rate for Payer: United Healthcare All Payer |
$7,525.77
|
|
|
TRI CEMENTED STEM 9MM*100MM
|
Facility
|
IP
|
$8,552.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,565.60 |
| Max. Negotiated Rate |
$8,209.93 |
| Rate for Payer: Aetna Commercial |
$6,585.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,670.57
|
| Rate for Payer: Cash Price |
$4,276.01
|
| Rate for Payer: Cigna Commercial |
$7,098.17
|
| Rate for Payer: First Health Commercial |
$8,124.41
|
| Rate for Payer: Humana Commercial |
$7,269.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,012.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,311.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,565.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,525.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,414.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,841.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,440.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,900.89
|
| Rate for Payer: PHCS Commercial |
$8,209.93
|
| Rate for Payer: United Healthcare All Payer |
$7,525.77
|
|
|
TRICHROME STAIN
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
30001333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.56
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.11
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
TRICHROME STAIN
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
30001333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$17.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.98
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$17.98
|
| Rate for Payer: Humana Medicare Advantage |
$17.98
|
| Rate for Payer: Kentucky WC Medicaid |
$18.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.11
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
TRICOMONAS VAGINALIS PCR
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
30001401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$32.09
|
| Rate for Payer: Healthspan PPO |
$35.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$177.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$103.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
TRICOMONAS VAGINALIS PCR
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
30001401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$236.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$244.85
|
| Rate for Payer: First Health Commercial |
$280.25
|
| Rate for Payer: Humana Commercial |
$250.75
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.60
|
| Rate for Payer: Ohio Health Group HMO |
$221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.55
|
| Rate for Payer: PHCS Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Payer |
$259.60
|
|
|
TRICOMONAS VAGINALIS PCR
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
30001401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$236.88
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$244.85
|
| Rate for Payer: First Health Commercial |
$280.25
|
| Rate for Payer: Humana Commercial |
$250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.60
|
| Rate for Payer: Ohio Health Group HMO |
$221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.55
|
| Rate for Payer: PHCS Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Payer |
$259.60
|
|
|
TRICOR FENOFIBRATE 145 MG TAB
|
Facility
|
IP
|
$4.85
|
|
|
Service Code
|
NDC 378306677
|
| Hospital Charge Code |
25001593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.61
|
| Rate for Payer: Humana Commercial |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.27
|
| Rate for Payer: Ohio Health Group HMO |
$3.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.35
|
| Rate for Payer: PHCS Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Payer |
$4.27
|
|
|
TRICOR FENOFIBRATE 145 MG TAB
|
Facility
|
OP
|
$4.85
|
|
|
Service Code
|
NDC 378306677
|
| Hospital Charge Code |
25001593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.61
|
| Rate for Payer: Humana Commercial |
$4.12
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.27
|
| Rate for Payer: Ohio Health Group HMO |
$3.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.35
|
| Rate for Payer: PHCS Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Payer |
$4.27
|
|
|
TRICOR(FENOFIBRATE)48MG TAB
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 65862076890
|
| Hospital Charge Code |
25001594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
TRICOR(FENOFIBRATE)48MG TAB
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 65862076890
|
| Hospital Charge Code |
25001594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
TRIDENT 0^ CONSTRAINED INSERT
|
Facility
|
OP
|
$15,694.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,708.40 |
| Max. Negotiated Rate |
$15,066.87 |
| Rate for Payer: Aetna Commercial |
$12,084.89
|
| Rate for Payer: Aetna Commercial |
$12,172.72
|
| Rate for Payer: Anthem Medicaid |
$5,397.39
|
| Rate for Payer: Anthem Medicaid |
$5,436.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,241.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,330.81
|
| Rate for Payer: Cash Price |
$7,847.33
|
| Rate for Payer: Cash Price |
$7,904.36
|
| Rate for Payer: Cigna Commercial |
$13,121.25
|
| Rate for Payer: Cigna Commercial |
$13,026.57
|
| Rate for Payer: First Health Commercial |
$15,018.29
|
| Rate for Payer: First Health Commercial |
$14,909.93
|
| Rate for Payer: Humana Commercial |
$13,340.46
|
| Rate for Payer: Humana Commercial |
$13,437.42
|
| Rate for Payer: Humana KY Medicaid |
$5,397.39
|
| Rate for Payer: Humana KY Medicaid |
$5,436.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,491.95
|
| Rate for Payer: Kentucky WC Medicaid |
$5,452.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,869.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,963.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,666.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,582.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,742.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,708.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,505.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,545.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,811.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,911.68
|
| Rate for Payer: Ohio Health Group HMO |
$11,771.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,856.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,555.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,646.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,654.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,753.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,829.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,908.02
|
| Rate for Payer: PHCS Commercial |
$15,176.38
|
| Rate for Payer: PHCS Commercial |
$15,066.87
|
| Rate for Payer: United Healthcare All Payer |
$13,911.68
|
| Rate for Payer: United Healthcare All Payer |
$13,811.30
|
|
