|
TRNSCND FEM HD 36M TPR XLG NCK
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
TROBRADEX
|
Facility
|
IP
|
$30.10
|
|
|
Service Code
|
NDC 78087601
|
| Hospital Charge Code |
25001604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Aetna Commercial |
$23.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.48
|
| Rate for Payer: Cash Price |
$15.05
|
| Rate for Payer: Cigna Commercial |
$24.98
|
| Rate for Payer: First Health Commercial |
$28.59
|
| Rate for Payer: Humana Commercial |
$25.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.49
|
| Rate for Payer: Ohio Health Group HMO |
$22.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.77
|
| Rate for Payer: PHCS Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Payer |
$26.49
|
|
|
TROBRADEX
|
Facility
|
OP
|
$30.10
|
|
|
Service Code
|
NDC 78087601
|
| Hospital Charge Code |
25001604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Aetna Commercial |
$23.18
|
| Rate for Payer: Anthem Medicaid |
$10.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.48
|
| Rate for Payer: Cash Price |
$15.05
|
| Rate for Payer: Cigna Commercial |
$24.98
|
| Rate for Payer: First Health Commercial |
$28.59
|
| Rate for Payer: Humana Commercial |
$25.59
|
| Rate for Payer: Humana KY Medicaid |
$10.35
|
| Rate for Payer: Kentucky WC Medicaid |
$10.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.49
|
| Rate for Payer: Ohio Health Group HMO |
$22.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.77
|
| Rate for Payer: PHCS Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Payer |
$26.49
|
|
|
TROCAR TIP WIRE 0.9MM 150MM
|
Facility
|
IP
|
$1,988.79
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.64 |
| Max. Negotiated Rate |
$1,909.24 |
| Rate for Payer: Aetna Commercial |
$1,531.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.26
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Cigna Commercial |
$1,650.70
|
| Rate for Payer: First Health Commercial |
$1,889.35
|
| Rate for Payer: Humana Commercial |
$1,690.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.27
|
| Rate for Payer: PHCS Commercial |
$1,909.24
|
| Rate for Payer: United Healthcare All Payer |
$1,750.14
|
|
|
TROCAR TIP WIRE 0.9MM 150MM
|
Facility
|
OP
|
$1,988.79
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.64 |
| Max. Negotiated Rate |
$1,909.24 |
| Rate for Payer: Aetna Commercial |
$1,531.37
|
| Rate for Payer: Anthem Medicaid |
$683.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.26
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Cigna Commercial |
$1,650.70
|
| Rate for Payer: First Health Commercial |
$1,889.35
|
| Rate for Payer: Humana Commercial |
$1,690.47
|
| Rate for Payer: Humana KY Medicaid |
$683.94
|
| Rate for Payer: Kentucky WC Medicaid |
$690.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.27
|
| Rate for Payer: PHCS Commercial |
$1,909.24
|
| Rate for Payer: United Healthcare All Payer |
$1,750.14
|
|
|
TROCAR TIPWIRE2X END 1.1 150MM
|
Facility
|
IP
|
$3,109.02
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$932.71 |
| Max. Negotiated Rate |
$2,984.66 |
| Rate for Payer: Aetna Commercial |
$2,393.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,425.04
|
| Rate for Payer: Cash Price |
$1,554.51
|
| Rate for Payer: Cigna Commercial |
$2,580.49
|
| Rate for Payer: First Health Commercial |
$2,953.57
|
| Rate for Payer: Humana Commercial |
$2,642.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,294.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$932.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,735.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,331.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,487.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,704.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,145.22
|
| Rate for Payer: PHCS Commercial |
$2,984.66
|
| Rate for Payer: United Healthcare All Payer |
$2,735.94
|
|
|
TROCAR TIPWIRE2X END 1.1 150MM
|
Facility
|
OP
|
$3,109.02
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$932.71 |
| Max. Negotiated Rate |
$2,984.66 |
| Rate for Payer: Aetna Commercial |
$2,393.95
|
| Rate for Payer: Anthem Medicaid |
$1,069.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,425.04
|
| Rate for Payer: Cash Price |
$1,554.51
|
| Rate for Payer: Cigna Commercial |
$2,580.49
|
| Rate for Payer: First Health Commercial |
$2,953.57
|
| Rate for Payer: Humana Commercial |
$2,642.67
|
| Rate for Payer: Humana KY Medicaid |
$1,069.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,080.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,294.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$932.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,090.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,735.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,331.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,487.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,704.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,145.22
|
| Rate for Payer: PHCS Commercial |
$2,984.66
|
| Rate for Payer: United Healthcare All Payer |
$2,735.94
|
|
|
TROCAR TIPWIRE2X END 1.6 150MM
|
Facility
|
IP
|
$1,988.79
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.64 |
| Max. Negotiated Rate |
$1,909.24 |
| Rate for Payer: Aetna Commercial |
$1,531.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.26
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Cigna Commercial |
$1,650.70
|
| Rate for Payer: First Health Commercial |
$1,889.35
|
| Rate for Payer: Humana Commercial |
$1,690.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.27
|
| Rate for Payer: PHCS Commercial |
$1,909.24
|
| Rate for Payer: United Healthcare All Payer |
$1,750.14
|
|
|
TROCAR TIPWIRE2X END 1.6 150MM
|
Facility
|
OP
|
$1,988.79
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.64 |
| Max. Negotiated Rate |
$1,909.24 |
| Rate for Payer: Aetna Commercial |
$1,531.37
|
| Rate for Payer: Anthem Medicaid |
$683.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.26
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Cigna Commercial |
$1,650.70
|
| Rate for Payer: First Health Commercial |
$1,889.35
|
| Rate for Payer: Humana Commercial |
$1,690.47
|
| Rate for Payer: Humana KY Medicaid |
$683.94
|
| Rate for Payer: Kentucky WC Medicaid |
$690.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.27
|
| Rate for Payer: PHCS Commercial |
$1,909.24
|
| Rate for Payer: United Healthcare All Payer |
$1,750.14
|
|
|
TROCAR TIPWIRE2X END 2.0 150MM
|
Facility
|
OP
|
$1,988.79
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.64 |
| Max. Negotiated Rate |
$1,909.24 |
| Rate for Payer: Aetna Commercial |
$1,531.37
|
| Rate for Payer: Anthem Medicaid |
$683.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.26
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Cigna Commercial |
$1,650.70
|
| Rate for Payer: First Health Commercial |
$1,889.35
|
| Rate for Payer: Humana Commercial |
$1,690.47
|
| Rate for Payer: Humana KY Medicaid |
$683.94
|
| Rate for Payer: Kentucky WC Medicaid |
$690.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.27
|
| Rate for Payer: PHCS Commercial |
$1,909.24
|
| Rate for Payer: United Healthcare All Payer |
$1,750.14
|
|
|
TROCAR TIPWIRE2X END 2.0 150MM
|
Facility
|
IP
|
$1,988.79
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.64 |
| Max. Negotiated Rate |
$1,909.24 |
| Rate for Payer: Aetna Commercial |
$1,531.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.26
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Cigna Commercial |
$1,650.70
|
| Rate for Payer: First Health Commercial |
$1,889.35
|
| Rate for Payer: Humana Commercial |
$1,690.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.27
|
| Rate for Payer: PHCS Commercial |
$1,909.24
|
| Rate for Payer: United Healthcare All Payer |
$1,750.14
|
|
|
TROCAR TI WIRE 2XEND1.25 150MM
|
Facility
|
OP
|
$1,988.79
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.64 |
| Max. Negotiated Rate |
$1,909.24 |
| Rate for Payer: Aetna Commercial |
$1,531.37
|
| Rate for Payer: Anthem Medicaid |
$683.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.26
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Cigna Commercial |
$1,650.70
|
| Rate for Payer: First Health Commercial |
$1,889.35
|
| Rate for Payer: Humana Commercial |
$1,690.47
|
| Rate for Payer: Humana KY Medicaid |
$683.94
|
| Rate for Payer: Kentucky WC Medicaid |
$690.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.27
|
| Rate for Payer: PHCS Commercial |
$1,909.24
|
| Rate for Payer: United Healthcare All Payer |
$1,750.14
|
|
|
TROCAR TI WIRE 2XEND1.25 150MM
|
Facility
|
IP
|
$1,988.79
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.64 |
| Max. Negotiated Rate |
$1,909.24 |
| Rate for Payer: Aetna Commercial |
$1,531.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.26
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Cigna Commercial |
$1,650.70
|
| Rate for Payer: First Health Commercial |
$1,889.35
|
| Rate for Payer: Humana Commercial |
$1,690.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.27
|
| Rate for Payer: PHCS Commercial |
$1,909.24
|
| Rate for Payer: United Healthcare All Payer |
$1,750.14
|
|
|
TROCH NAIL 10MM*170*125^
|
Facility
|
OP
|
$8,537.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,561.11 |
| Max. Negotiated Rate |
$8,195.57 |
| Rate for Payer: Aetna Commercial |
$6,573.53
|
| Rate for Payer: Anthem Medicaid |
$2,935.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,658.90
|
| Rate for Payer: Cash Price |
$4,268.52
|
| Rate for Payer: Cigna Commercial |
$7,085.75
|
| Rate for Payer: First Health Commercial |
$8,110.20
|
| Rate for Payer: Humana Commercial |
$7,256.49
|
| Rate for Payer: Humana KY Medicaid |
$2,935.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,965.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,000.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,300.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,561.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,994.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,512.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,402.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,829.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,427.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,890.56
|
| Rate for Payer: PHCS Commercial |
$8,195.57
|
| Rate for Payer: United Healthcare All Payer |
$7,512.60
|
|
|
TROCH NAIL 10MM*170*125^
|
Facility
|
IP
|
$8,537.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,561.11 |
| Max. Negotiated Rate |
$8,195.57 |
| Rate for Payer: Aetna Commercial |
$6,573.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,658.90
|
| Rate for Payer: Cash Price |
$4,268.52
|
| Rate for Payer: Cigna Commercial |
$7,085.75
|
| Rate for Payer: First Health Commercial |
$8,110.20
|
| Rate for Payer: Humana Commercial |
$7,256.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,000.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,300.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,561.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,512.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,402.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,829.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,427.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,890.56
|
| Rate for Payer: PHCS Commercial |
$8,195.57
|
| Rate for Payer: United Healthcare All Payer |
$7,512.60
|
|
|
TRODELVY 2.5mg (180mg SDV)
|
Facility
|
IP
|
$13,697.16
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
25004424
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,109.15 |
| Max. Negotiated Rate |
$13,149.27 |
| Rate for Payer: Aetna Commercial |
$10,546.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,683.78
|
| Rate for Payer: Cash Price |
$6,848.58
|
| Rate for Payer: Cigna Commercial |
$11,368.64
|
| Rate for Payer: First Health Commercial |
$13,012.30
|
| Rate for Payer: Humana Commercial |
$11,642.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,231.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,108.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,109.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,272.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,957.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,916.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,451.04
|
| Rate for Payer: PHCS Commercial |
$13,149.27
|
| Rate for Payer: United Healthcare All Payer |
$12,053.50
|
|
|
TRODELVY 2.5mg (180mg SDV)
|
Facility
|
OP
|
$13,697.16
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
25004424
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$13,149.27 |
| Rate for Payer: Aetna Commercial |
$10,546.81
|
| Rate for Payer: Anthem Medicaid |
$4,710.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$36.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,683.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$50.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.95
|
| Rate for Payer: Cash Price |
$6,848.58
|
| Rate for Payer: Cash Price |
$6,848.58
|
| Rate for Payer: Cigna Commercial |
$11,368.64
|
| Rate for Payer: First Health Commercial |
$13,012.30
|
| Rate for Payer: Humana Commercial |
$11,642.59
|
| Rate for Payer: Humana KY Medicaid |
$4,710.45
|
| Rate for Payer: Humana Medicare Advantage |
$36.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,758.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,231.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,108.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,804.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,272.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,957.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,916.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,451.04
|
| Rate for Payer: PHCS Commercial |
$13,149.27
|
| Rate for Payer: United Healthcare All Payer |
$12,053.50
|
|
|
TROPHAMINE 10% 500ML Bag
|
Facility
|
OP
|
$200.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004422
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$192.62 |
| Rate for Payer: Aetna Commercial |
$154.50
|
| Rate for Payer: Anthem Medicaid |
$69.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.51
|
| Rate for Payer: Cash Price |
$100.33
|
| Rate for Payer: Cigna Commercial |
$166.54
|
| Rate for Payer: First Health Commercial |
$190.62
|
| Rate for Payer: Humana Commercial |
$170.55
|
| Rate for Payer: Humana KY Medicaid |
$69.00
|
| Rate for Payer: Kentucky WC Medicaid |
$69.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.57
|
| Rate for Payer: Ohio Health Group HMO |
$150.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.45
|
| Rate for Payer: PHCS Commercial |
$192.62
|
| Rate for Payer: United Healthcare All Payer |
$176.57
|
|
|
TROPHAMINE 10% 500ML Bag
|
Facility
|
IP
|
$200.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004422
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$192.62 |
| Rate for Payer: Aetna Commercial |
$154.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.51
|
| Rate for Payer: Cash Price |
$100.33
|
| Rate for Payer: Cigna Commercial |
$166.54
|
| Rate for Payer: First Health Commercial |
$190.62
|
| Rate for Payer: Humana Commercial |
$170.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.57
|
| Rate for Payer: Ohio Health Group HMO |
$150.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.45
|
| Rate for Payer: PHCS Commercial |
$192.62
|
| Rate for Payer: United Healthcare All Payer |
$176.57
|
|
|
TROPICAMIDE 1% 3ML
|
Facility
|
OP
|
$85.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004592
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Aetna Commercial |
$65.60
|
| Rate for Payer: Anthem Medicaid |
$29.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.46
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$70.72
|
| Rate for Payer: First Health Commercial |
$80.94
|
| Rate for Payer: Humana Commercial |
$72.42
|
| Rate for Payer: Humana KY Medicaid |
$29.30
|
| Rate for Payer: Kentucky WC Medicaid |
$29.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.98
|
| Rate for Payer: Ohio Health Group HMO |
$63.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.79
|
| Rate for Payer: PHCS Commercial |
$81.79
|
| Rate for Payer: United Healthcare All Payer |
$74.98
|
|
|
TROPICAMIDE 1% 3ML
|
Facility
|
IP
|
$85.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004592
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Aetna Commercial |
$65.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.46
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$70.72
|
| Rate for Payer: First Health Commercial |
$80.94
|
| Rate for Payer: Humana Commercial |
$72.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.98
|
| Rate for Payer: Ohio Health Group HMO |
$63.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.79
|
| Rate for Payer: PHCS Commercial |
$81.79
|
| Rate for Payer: United Healthcare All Payer |
$74.98
|
|
|
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 |
$16.83
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.96
|
|
|
TROPONIN- QUANTITATIVE
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
30000545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$14.38
|
| Rate for Payer: Ambetter Exchange |
$12.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.96
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$8.62
|
| Rate for Payer: Healthspan PPO |
$10.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.47
|
| Rate for Payer: Multiplan PHCS |
$81.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16.21
|
| Rate for Payer: UHCCP Medicaid |
$47.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.47
|
|
|
TROPONIN- QUANTITATIVE
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
30000545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem Medicaid |
$12.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.47
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Humana KY Medicaid |
$12.47
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: Kentucky WC Medicaid |
$12.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.84
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
TROPONIN- QUANTITATIVE
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
30000545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.21
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.84
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
