|
INDERAL LA(PROPRANOL 80MG/1CAP
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
NDC 527411737
|
| Hospital Charge Code |
25000778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
INDERAL (PROPRANOLOL 10MG/1TAB
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
25000775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
INDERAL (PROPRANOLOL 10MG/1TAB
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
25000775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
INDERAL (PROPRANOLOL) 1MG/1ML
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
25003121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
INDERAL (PROPRANOLOL) 1MG/1ML
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
25003121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
INDERAL (PROPRANOLOL 20MG/1TAB
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 60687059801
|
| Hospital Charge Code |
25000776
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.87
|
| Rate for Payer: First Health Commercial |
$4.43
|
| Rate for Payer: Humana Commercial |
$3.96
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.10
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
|
|
INDERAL (PROPRANOLOL 20MG/1TAB
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 60687059801
|
| Hospital Charge Code |
25000776
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Humana Commercial |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.10
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.87
|
| Rate for Payer: First Health Commercial |
$4.43
|
|
|
INDIGO 3 W/TUBING
|
Facility
|
OP
|
$8,377.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,089.04 |
| Max. Negotiated Rate |
$8,042.11 |
| Rate for Payer: Aetna Commercial |
$6,450.44
|
| Rate for Payer: Anthem Medicaid |
$2,880.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,534.22
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cigna Commercial |
$6,953.08
|
| Rate for Payer: First Health Commercial |
$7,958.34
|
| Rate for Payer: Humana Commercial |
$7,120.62
|
| Rate for Payer: Humana KY Medicaid |
$2,880.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,910.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,869.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,182.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,513.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,938.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.93
|
| Rate for Payer: PHCS Commercial |
$8,042.11
|
| Rate for Payer: United Healthcare All Payer |
$7,371.94
|
|
|
INDIGO 3 W/TUBING
|
Facility
|
IP
|
$8,377.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,089.04 |
| Max. Negotiated Rate |
$8,042.11 |
| Rate for Payer: Aetna Commercial |
$6,450.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,534.22
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cigna Commercial |
$6,953.08
|
| Rate for Payer: First Health Commercial |
$7,958.34
|
| Rate for Payer: Humana Commercial |
$7,120.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,869.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,182.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,513.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.93
|
| Rate for Payer: PHCS Commercial |
$8,042.11
|
| Rate for Payer: United Healthcare All Payer |
$7,371.94
|
|
|
INDIGO 5 W/TUBING
|
Facility
|
OP
|
$8,377.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,089.04 |
| Max. Negotiated Rate |
$8,042.11 |
| Rate for Payer: Aetna Commercial |
$6,450.44
|
| Rate for Payer: Anthem Medicaid |
$2,880.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,534.22
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cigna Commercial |
$6,953.08
|
| Rate for Payer: First Health Commercial |
$7,958.34
|
| Rate for Payer: Humana Commercial |
$7,120.62
|
| Rate for Payer: Humana KY Medicaid |
$2,880.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,910.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,869.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,182.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,513.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,938.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.93
|
| Rate for Payer: PHCS Commercial |
$8,042.11
|
| Rate for Payer: United Healthcare All Payer |
$7,371.94
|
|
|
INDIGO 5 W/TUBING
|
Facility
|
IP
|
$8,377.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,089.04 |
| Max. Negotiated Rate |
$8,042.11 |
| Rate for Payer: Aetna Commercial |
$6,450.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,534.22
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cigna Commercial |
$6,953.08
|
| Rate for Payer: First Health Commercial |
$7,958.34
|
| Rate for Payer: Humana Commercial |
$7,120.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,869.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,182.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,513.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.93
|
| Rate for Payer: PHCS Commercial |
$8,042.11
|
| Rate for Payer: United Healthcare All Payer |
$7,371.94
|
|
|
INDIGO 6 W/TUBING
|
Facility
|
OP
|
$11,530.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,499.00 |
| Max. Negotiated Rate |
$11,069.52 |
| Rate for Payer: Aetna Commercial |
$8,878.68
|
| Rate for Payer: Anthem Medicaid |
$3,965.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,993.98
|
| Rate for Payer: Cash Price |
$5,765.38
|
| Rate for Payer: Cigna Commercial |
$9,570.52
|
| Rate for Payer: First Health Commercial |
$10,954.21
|
| Rate for Payer: Humana Commercial |
$9,801.14
|
| Rate for Payer: Humana KY Medicaid |
$3,965.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,005.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,455.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,509.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,459.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,044.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,147.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,648.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,306.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,574.53
|
| Rate for Payer: PHCS Commercial |
$11,069.52
|
| Rate for Payer: United Healthcare All Payer |
$10,147.06
|
|
|
INDIGO 6 W/TUBING
|
Facility
|
IP
|
$11,530.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,499.00 |
| Max. Negotiated Rate |
$11,069.52 |
| Rate for Payer: Aetna Commercial |
$8,878.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,993.98
|
| Rate for Payer: Cash Price |
$5,765.38
|
| Rate for Payer: Cigna Commercial |
$9,570.52
|
| Rate for Payer: First Health Commercial |
$10,954.21
|
| Rate for Payer: Humana Commercial |
$9,801.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,455.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,509.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,459.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,147.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,648.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,306.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,574.53
|
| Rate for Payer: PHCS Commercial |
$11,069.52
|
| Rate for Payer: United Healthcare All Payer |
$10,147.06
|
|
|
INDIGO 7D XTORQ + DYNAMIC
|
Facility
|
IP
|
$13,118.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,705.40 |
| Max. Negotiated Rate |
$12,593.76 |
| Rate for Payer: Aetna Commercial |
$10,101.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,232.43
|
| Rate for Payer: Cash Price |
$6,559.25
|
| Rate for Payer: Cigna Commercial |
$10,888.36
|
| Rate for Payer: First Health Commercial |
$12,462.58
|
| Rate for Payer: Humana Commercial |
$11,150.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,757.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,681.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,935.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,544.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,838.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,623.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,705.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,066.74
|
| Rate for Payer: PHCS Commercial |
$12,593.76
|
| Rate for Payer: United Healthcare All Payer |
$11,544.28
|
|
|
INDIGO 7D XTORQ + DYNAMIC
|
Facility
|
OP
|
$13,118.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,705.40 |
| Max. Negotiated Rate |
$12,593.76 |
| Rate for Payer: Aetna Commercial |
$10,101.24
|
| Rate for Payer: Anthem Medicaid |
$4,511.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,232.43
|
| Rate for Payer: Cash Price |
$6,559.25
|
| Rate for Payer: Cigna Commercial |
$10,888.36
|
| Rate for Payer: First Health Commercial |
$12,462.58
|
| Rate for Payer: Humana Commercial |
$11,150.72
|
| Rate for Payer: Humana KY Medicaid |
$4,511.45
|
| Rate for Payer: Kentucky WC Medicaid |
$4,557.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,757.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,681.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,935.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,601.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,544.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,838.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,623.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,705.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,066.74
|
| Rate for Payer: PHCS Commercial |
$12,593.76
|
| Rate for Payer: United Healthcare All Payer |
$11,544.28
|
|
|
INDIGO 8 ST TIP W/TUBING
|
Facility
|
OP
|
$15,918.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,069.34 |
| Max. Negotiated Rate |
$15,281.28 |
| Rate for Payer: Aetna Commercial |
$12,256.86
|
| Rate for Payer: Anthem Medicaid |
$5,474.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,416.04
|
| Rate for Payer: Cash Price |
$7,959.00
|
| Rate for Payer: Cigna Commercial |
$13,211.94
|
| Rate for Payer: First Health Commercial |
$15,122.10
|
| Rate for Payer: Humana Commercial |
$13,530.30
|
| Rate for Payer: Humana KY Medicaid |
$5,474.20
|
| Rate for Payer: Kentucky WC Medicaid |
$5,529.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,747.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,775.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,584.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,938.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,069.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,934.58
|
| Rate for Payer: PHCS Commercial |
$15,281.28
|
| Rate for Payer: United Healthcare All Payer |
$14,007.84
|
|
|
INDIGO 8 ST TIP W/TUBING
|
Facility
|
IP
|
$15,918.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,069.34 |
| Max. Negotiated Rate |
$15,281.28 |
| Rate for Payer: Aetna Commercial |
$12,256.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,416.04
|
| Rate for Payer: Cash Price |
$7,959.00
|
| Rate for Payer: Cigna Commercial |
$13,211.94
|
| Rate for Payer: First Health Commercial |
$15,122.10
|
| Rate for Payer: Humana Commercial |
$13,530.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,747.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,775.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,938.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,069.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,934.58
|
| Rate for Payer: PHCS Commercial |
$15,281.28
|
| Rate for Payer: United Healthcare All Payer |
$14,007.84
|
|
|
INDIGO 8 TORQ TIP W/TUBING
|
Facility
|
IP
|
$15,918.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,069.34 |
| Max. Negotiated Rate |
$15,281.28 |
| Rate for Payer: Aetna Commercial |
$12,256.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,416.04
|
| Rate for Payer: Cash Price |
$7,959.00
|
| Rate for Payer: Cigna Commercial |
$13,211.94
|
| Rate for Payer: First Health Commercial |
$15,122.10
|
| Rate for Payer: Humana Commercial |
$13,530.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,747.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,775.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,938.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,069.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,934.58
|
| Rate for Payer: PHCS Commercial |
$15,281.28
|
| Rate for Payer: United Healthcare All Payer |
$14,007.84
|
|
|
INDIGO 8 TORQ TIP W/TUBING
|
Facility
|
OP
|
$15,918.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,069.34 |
| Max. Negotiated Rate |
$15,281.28 |
| Rate for Payer: Aetna Commercial |
$12,256.86
|
| Rate for Payer: Anthem Medicaid |
$5,474.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,416.04
|
| Rate for Payer: Cash Price |
$7,959.00
|
| Rate for Payer: Cigna Commercial |
$13,211.94
|
| Rate for Payer: First Health Commercial |
$15,122.10
|
| Rate for Payer: Humana Commercial |
$13,530.30
|
| Rate for Payer: Humana KY Medicaid |
$5,474.20
|
| Rate for Payer: Kentucky WC Medicaid |
$5,529.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,747.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,775.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,584.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,938.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,069.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,934.58
|
| Rate for Payer: PHCS Commercial |
$15,281.28
|
| Rate for Payer: United Healthcare All Payer |
$14,007.84
|
|
|
INDIGO 8 XTORQ TIP W/TUBING
|
Facility
|
IP
|
$15,918.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,069.34 |
| Max. Negotiated Rate |
$15,281.28 |
| Rate for Payer: Aetna Commercial |
$12,256.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,416.04
|
| Rate for Payer: Cash Price |
$7,959.00
|
| Rate for Payer: Cigna Commercial |
$13,211.94
|
| Rate for Payer: First Health Commercial |
$15,122.10
|
| Rate for Payer: Humana Commercial |
$13,530.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,747.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,775.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,938.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,069.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,934.58
|
| Rate for Payer: PHCS Commercial |
$15,281.28
|
| Rate for Payer: United Healthcare All Payer |
$14,007.84
|
|
|
INDIGO 8 XTORQ TIP W/TUBING
|
Facility
|
OP
|
$15,918.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,069.34 |
| Max. Negotiated Rate |
$15,281.28 |
| Rate for Payer: Cigna Commercial |
$13,211.94
|
| Rate for Payer: First Health Commercial |
$15,122.10
|
| Rate for Payer: Humana Commercial |
$13,530.30
|
| Rate for Payer: Humana KY Medicaid |
$5,474.20
|
| Rate for Payer: Kentucky WC Medicaid |
$5,529.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,747.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,775.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,584.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,938.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,069.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,934.58
|
| Rate for Payer: PHCS Commercial |
$15,281.28
|
| Rate for Payer: United Healthcare All Payer |
$14,007.84
|
| Rate for Payer: Aetna Commercial |
$12,256.86
|
| Rate for Payer: Anthem Medicaid |
$5,474.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,416.04
|
| Rate for Payer: Cash Price |
$7,959.00
|
|
|
INDIGO ASPIRATION TUBING
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.29 |
| Max. Negotiated Rate |
$3,583.68 |
| Rate for Payer: Aetna Commercial |
$2,874.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,911.74
|
| Rate for Payer: Cash Price |
$1,866.50
|
| Rate for Payer: Cigna Commercial |
$3,098.39
|
| Rate for Payer: First Health Commercial |
$3,546.35
|
| Rate for Payer: Humana Commercial |
$3,173.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,061.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,754.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,285.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,799.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,157.23
|
| Rate for Payer: PHCS Commercial |
$3,583.68
|
| Rate for Payer: United Healthcare All Payer |
$3,285.04
|
|
|
INDIGO ASPIRATION TUBING
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.29 |
| Max. Negotiated Rate |
$3,583.68 |
| Rate for Payer: Aetna Commercial |
$2,874.41
|
| Rate for Payer: Anthem Medicaid |
$1,283.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,911.74
|
| Rate for Payer: Cash Price |
$1,866.50
|
| Rate for Payer: Cigna Commercial |
$3,098.39
|
| Rate for Payer: First Health Commercial |
$3,546.35
|
| Rate for Payer: Humana Commercial |
$3,173.05
|
| Rate for Payer: Humana KY Medicaid |
$1,283.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,061.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,754.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,309.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,285.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,799.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,157.23
|
| Rate for Payer: PHCS Commercial |
$3,583.68
|
| Rate for Payer: United Healthcare All Payer |
$3,285.04
|
|
|
INDIGO CATH
|
Facility
|
OP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem Medicaid |
$3,398.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Humana KY Medicaid |
$3,398.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,432.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,466.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
|
INDIGO CATH
|
Facility
|
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
