|
INDIGO CATH 12+ LIGHTNING
|
Facility
|
IP
|
$29,656.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,855.34 |
| Max. Negotiated Rate |
$28,470.24 |
| Rate for Payer: Aetna Commercial |
$22,835.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,132.07
|
| Rate for Payer: Cash Price |
$14,828.25
|
| Rate for Payer: Cigna Commercial |
$24,614.90
|
| Rate for Payer: First Health Commercial |
$28,173.68
|
| Rate for Payer: Humana Commercial |
$25,208.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,318.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,886.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,896.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,097.72
|
| Rate for Payer: Ohio Health Group HMO |
$22,242.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,931.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,855.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,193.52
|
| Rate for Payer: PHCS Commercial |
$28,470.24
|
| Rate for Payer: United Healthcare All Payer |
$26,097.72
|
|
|
INDIGO CATH 12+ LIGHTNING
|
Facility
|
OP
|
$29,656.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,855.34 |
| Max. Negotiated Rate |
$28,470.24 |
| Rate for Payer: Aetna Commercial |
$22,835.50
|
| Rate for Payer: Anthem Medicaid |
$10,198.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,132.07
|
| Rate for Payer: Cash Price |
$14,828.25
|
| Rate for Payer: Cigna Commercial |
$24,614.90
|
| Rate for Payer: First Health Commercial |
$28,173.68
|
| Rate for Payer: Humana Commercial |
$25,208.02
|
| Rate for Payer: Humana KY Medicaid |
$10,198.87
|
| Rate for Payer: Kentucky WC Medicaid |
$10,302.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,318.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,886.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,896.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,403.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,097.72
|
| Rate for Payer: Ohio Health Group HMO |
$22,242.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,931.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,855.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,193.52
|
| Rate for Payer: PHCS Commercial |
$28,470.24
|
| Rate for Payer: United Healthcare All Payer |
$26,097.72
|
|
|
INDIGO CATH 3
|
Facility
|
IP
|
$7,044.95
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.84 |
| Max. Negotiated Rate |
$6,763.15 |
| Rate for Payer: Aetna Commercial |
$5,424.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,495.06
|
| Rate for Payer: Cash Price |
$3,522.48
|
| Rate for Payer: Cigna Commercial |
$5,847.31
|
| Rate for Payer: First Health Commercial |
$6,692.70
|
| Rate for Payer: Humana Commercial |
$5,988.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,776.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,199.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,199.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,283.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.93
|
| Rate for Payer: PHCS Commercial |
$6,763.15
|
| Rate for Payer: United Healthcare All Payer |
$6,199.56
|
|
|
INDIGO CATH 3
|
Facility
|
OP
|
$7,044.95
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.84 |
| Max. Negotiated Rate |
$6,763.15 |
| Rate for Payer: Aetna Commercial |
$5,424.61
|
| Rate for Payer: Anthem Medicaid |
$2,422.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,495.06
|
| Rate for Payer: Cash Price |
$3,522.48
|
| Rate for Payer: Cigna Commercial |
$5,847.31
|
| Rate for Payer: First Health Commercial |
$6,692.70
|
| Rate for Payer: Humana Commercial |
$5,988.21
|
| Rate for Payer: Humana KY Medicaid |
$2,422.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,447.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,776.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,199.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,471.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,199.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,283.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.93
|
| Rate for Payer: PHCS Commercial |
$6,763.15
|
| Rate for Payer: United Healthcare All Payer |
$6,199.56
|
|
|
INDIGO CATH 5
|
Facility
|
OP
|
$7,044.95
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.84 |
| Max. Negotiated Rate |
$6,763.15 |
| Rate for Payer: Aetna Commercial |
$5,424.61
|
| Rate for Payer: Anthem Medicaid |
$2,422.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,495.06
|
| Rate for Payer: Cash Price |
$3,522.48
|
| Rate for Payer: Cigna Commercial |
$5,847.31
|
| Rate for Payer: First Health Commercial |
$6,692.70
|
| Rate for Payer: Humana Commercial |
$5,988.21
|
| Rate for Payer: Humana KY Medicaid |
$2,422.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,447.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,776.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,199.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,471.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,199.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,283.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.93
|
| Rate for Payer: PHCS Commercial |
$6,763.15
|
| Rate for Payer: United Healthcare All Payer |
$6,199.56
|
|
|
INDIGO CATH 5
|
Facility
|
IP
|
$7,044.95
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.84 |
| Max. Negotiated Rate |
$6,763.15 |
| Rate for Payer: Aetna Commercial |
$5,424.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,495.06
|
| Rate for Payer: Cash Price |
$3,522.48
|
| Rate for Payer: Cigna Commercial |
$5,847.31
|
| Rate for Payer: First Health Commercial |
$6,692.70
|
| Rate for Payer: Humana Commercial |
$5,988.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,776.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,199.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,199.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,283.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.93
|
| Rate for Payer: PHCS Commercial |
$6,763.15
|
| Rate for Payer: United Healthcare All Payer |
$6,199.56
|
|
|
INDIGO CATH 6 ST 135CM
|
Facility
|
OP
|
$9,698.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,260.80 |
| Max. Negotiated Rate |
$9,310.56 |
| Rate for Payer: Aetna Commercial |
$7,467.84
|
| Rate for Payer: Anthem Medicaid |
$3,335.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,564.83
|
| Rate for Payer: Cash Price |
$4,849.25
|
| Rate for Payer: Cigna Commercial |
$8,049.76
|
| Rate for Payer: First Health Commercial |
$9,213.58
|
| Rate for Payer: Humana Commercial |
$8,243.72
|
| Rate for Payer: Humana KY Medicaid |
$3,335.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,369.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,952.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,157.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,909.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,402.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,534.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,273.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,939.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,260.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,006.54
|
| Rate for Payer: PHCS Commercial |
$9,310.56
|
| Rate for Payer: United Healthcare All Payer |
$8,534.68
|
|
|
INDIGO CATH 6 ST 135CM
|
Facility
|
IP
|
$9,698.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,260.80 |
| Max. Negotiated Rate |
$9,310.56 |
| Rate for Payer: Aetna Commercial |
$7,467.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,564.83
|
| Rate for Payer: Cash Price |
$4,849.25
|
| Rate for Payer: Cigna Commercial |
$8,049.76
|
| Rate for Payer: First Health Commercial |
$9,213.58
|
| Rate for Payer: Humana Commercial |
$8,243.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,952.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,157.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,909.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,534.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,273.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,939.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,260.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,006.54
|
| Rate for Payer: PHCS Commercial |
$9,310.56
|
| Rate for Payer: United Healthcare All Payer |
$8,534.68
|
|
|
INDIGO CATH 7+ LIGHTNING
|
Facility
|
IP
|
$25,276.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,285.94 |
| Max. Negotiated Rate |
$24,265.44 |
| Rate for Payer: Aetna Commercial |
$19,462.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,715.67
|
| Rate for Payer: Cash Price |
$12,638.25
|
| Rate for Payer: Cigna Commercial |
$20,979.50
|
| Rate for Payer: First Health Commercial |
$24,012.68
|
| Rate for Payer: Humana Commercial |
$21,485.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,726.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,654.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,582.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,243.32
|
| Rate for Payer: Ohio Health Group HMO |
$18,957.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,055.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,285.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,835.72
|
| Rate for Payer: PHCS Commercial |
$24,265.44
|
| Rate for Payer: United Healthcare All Payer |
$22,243.32
|
|
|
INDIGO CATH 7+ LIGHTNING
|
Facility
|
OP
|
$25,276.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,285.94 |
| Max. Negotiated Rate |
$24,265.44 |
| Rate for Payer: Aetna Commercial |
$19,462.90
|
| Rate for Payer: Anthem Medicaid |
$8,692.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,715.67
|
| Rate for Payer: Cash Price |
$12,638.25
|
| Rate for Payer: Cigna Commercial |
$20,979.50
|
| Rate for Payer: First Health Commercial |
$24,012.68
|
| Rate for Payer: Humana Commercial |
$21,485.02
|
| Rate for Payer: Humana KY Medicaid |
$8,692.59
|
| Rate for Payer: Kentucky WC Medicaid |
$8,781.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,726.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,654.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,582.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,867.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,243.32
|
| Rate for Payer: Ohio Health Group HMO |
$18,957.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,055.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,285.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,835.72
|
| Rate for Payer: PHCS Commercial |
$24,265.44
|
| Rate for Payer: United Healthcare All Payer |
$22,243.32
|
|
|
INDIGO CATH 8+ LIGHTNING
|
Facility
|
OP
|
$26,006.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,380.84 |
| Max. Negotiated Rate |
$24,966.24 |
| Rate for Payer: Aetna Commercial |
$20,025.00
|
| Rate for Payer: Anthem Medicaid |
$8,943.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,285.07
|
| Rate for Payer: Cash Price |
$13,003.25
|
| Rate for Payer: Cigna Commercial |
$21,585.40
|
| Rate for Payer: First Health Commercial |
$24,706.18
|
| Rate for Payer: Humana Commercial |
$22,105.52
|
| Rate for Payer: Humana KY Medicaid |
$8,943.64
|
| Rate for Payer: Kentucky WC Medicaid |
$9,034.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,325.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,192.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,801.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,123.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,885.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,504.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,201.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,380.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,062.02
|
| Rate for Payer: PHCS Commercial |
$24,966.24
|
| Rate for Payer: United Healthcare All Payer |
$22,885.72
|
|
|
INDIGO CATH 8+ LIGHTNING
|
Facility
|
IP
|
$26,006.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,380.84 |
| Max. Negotiated Rate |
$24,966.24 |
| Rate for Payer: Aetna Commercial |
$20,025.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,285.07
|
| Rate for Payer: Cash Price |
$13,003.25
|
| Rate for Payer: Cigna Commercial |
$21,585.40
|
| Rate for Payer: First Health Commercial |
$24,706.18
|
| Rate for Payer: Humana Commercial |
$22,105.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,325.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,192.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,801.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,885.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,504.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,201.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,380.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,062.02
|
| Rate for Payer: PHCS Commercial |
$24,966.24
|
| Rate for Payer: United Healthcare All Payer |
$22,885.72
|
|
|
INDIGO CATH 8 ST 85CM
|
Facility
|
IP
|
$14,140.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,838.26 |
| Max. Negotiated Rate |
$13,574.88 |
| Rate for Payer: Aetna Commercial |
$10,888.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,029.59
|
| Rate for Payer: Cash Price |
$7,070.25
|
| Rate for Payer: Cigna Commercial |
$11,736.62
|
| Rate for Payer: First Health Commercial |
$13,433.48
|
| Rate for Payer: Humana Commercial |
$12,019.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,595.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,435.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,242.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,443.64
|
| Rate for Payer: Ohio Health Group HMO |
$10,605.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,828.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,838.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,383.56
|
| Rate for Payer: PHCS Commercial |
$13,574.88
|
| Rate for Payer: United Healthcare All Payer |
$12,443.64
|
|
|
INDIGO CATH 8 ST 85CM
|
Facility
|
OP
|
$14,140.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,838.26 |
| Max. Negotiated Rate |
$13,574.88 |
| Rate for Payer: Aetna Commercial |
$10,888.18
|
| Rate for Payer: Anthem Medicaid |
$4,862.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,029.59
|
| Rate for Payer: Cash Price |
$7,070.25
|
| Rate for Payer: Cigna Commercial |
$11,736.62
|
| Rate for Payer: First Health Commercial |
$13,433.48
|
| Rate for Payer: Humana Commercial |
$12,019.42
|
| Rate for Payer: Humana KY Medicaid |
$4,862.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,912.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,595.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,435.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,242.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,960.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,443.64
|
| Rate for Payer: Ohio Health Group HMO |
$10,605.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,828.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,838.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,383.56
|
| Rate for Payer: PHCS Commercial |
$13,574.88
|
| Rate for Payer: United Healthcare All Payer |
$12,443.64
|
|
|
INDIGO CATH 8 TORQ TIP 85CM
|
Facility
|
IP
|
$13,848.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,800.30 |
| Max. Negotiated Rate |
$13,294.56 |
| Rate for Payer: Aetna Commercial |
$10,663.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,801.83
|
| Rate for Payer: Cash Price |
$6,924.25
|
| Rate for Payer: Cigna Commercial |
$11,494.26
|
| Rate for Payer: First Health Commercial |
$13,156.08
|
| Rate for Payer: Humana Commercial |
$11,771.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,355.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.68
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.04
|
| Rate for Payer: PHCS Commercial |
$13,294.56
|
| Rate for Payer: United Healthcare All Payer |
$12,186.68
|
|
|
INDIGO CATH 8 TORQ TIP 85CM
|
Facility
|
OP
|
$13,848.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,800.30 |
| Max. Negotiated Rate |
$13,294.56 |
| Rate for Payer: Aetna Commercial |
$10,663.34
|
| Rate for Payer: Anthem Medicaid |
$4,762.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,801.83
|
| Rate for Payer: Cash Price |
$6,924.25
|
| Rate for Payer: Cigna Commercial |
$11,494.26
|
| Rate for Payer: First Health Commercial |
$13,156.08
|
| Rate for Payer: Humana Commercial |
$11,771.22
|
| Rate for Payer: Humana KY Medicaid |
$4,762.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,810.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,355.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,858.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.68
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.04
|
| Rate for Payer: PHCS Commercial |
$13,294.56
|
| Rate for Payer: United Healthcare All Payer |
$12,186.68
|
|
|
INDIGO CATH 8 XTORQ TIP 115CM
|
Facility
|
OP
|
$13,848.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,800.30 |
| Max. Negotiated Rate |
$13,294.56 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,355.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,858.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.68
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.04
|
| Rate for Payer: PHCS Commercial |
$13,294.56
|
| Rate for Payer: United Healthcare All Payer |
$12,186.68
|
| Rate for Payer: Aetna Commercial |
$10,663.34
|
| Rate for Payer: Anthem Medicaid |
$4,762.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,801.83
|
| Rate for Payer: Cash Price |
$6,924.25
|
| Rate for Payer: Cigna Commercial |
$11,494.26
|
| Rate for Payer: First Health Commercial |
$13,156.08
|
| Rate for Payer: Humana Commercial |
$11,771.22
|
| Rate for Payer: Humana KY Medicaid |
$4,762.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,810.97
|
|
|
INDIGO CATH 8 XTORQ TIP 115CM
|
Facility
|
IP
|
$13,848.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,800.30 |
| Max. Negotiated Rate |
$13,294.56 |
| Rate for Payer: Aetna Commercial |
$10,663.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,801.83
|
| Rate for Payer: Cash Price |
$6,924.25
|
| Rate for Payer: Cigna Commercial |
$11,494.26
|
| Rate for Payer: First Health Commercial |
$13,156.08
|
| Rate for Payer: Humana Commercial |
$11,771.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,355.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.68
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.04
|
| Rate for Payer: PHCS Commercial |
$13,294.56
|
| Rate for Payer: United Healthcare All Payer |
$12,186.68
|
|
|
INDIGO SEPARATOR 6
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
INDIGO SEPARATOR 6
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
INDIGO SEPARATOR 8
|
Facility
|
IP
|
$9,662.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,256.06 |
| Max. Negotiated Rate |
$9,275.52 |
| Rate for Payer: Aetna Commercial |
$7,439.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,536.36
|
| Rate for Payer: Cash Price |
$4,831.00
|
| Rate for Payer: Cigna Commercial |
$8,019.46
|
| Rate for Payer: First Health Commercial |
$9,178.90
|
| Rate for Payer: Humana Commercial |
$8,212.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,922.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,130.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,898.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,502.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,246.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,932.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,256.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,995.22
|
| Rate for Payer: PHCS Commercial |
$9,275.52
|
| Rate for Payer: United Healthcare All Payer |
$8,502.56
|
|
|
INDIGO SEPARATOR 8
|
Facility
|
OP
|
$9,662.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,256.06 |
| Max. Negotiated Rate |
$9,275.52 |
| Rate for Payer: Aetna Commercial |
$7,439.74
|
| Rate for Payer: Anthem Medicaid |
$3,322.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,536.36
|
| Rate for Payer: Cash Price |
$4,831.00
|
| Rate for Payer: Cigna Commercial |
$8,019.46
|
| Rate for Payer: First Health Commercial |
$9,178.90
|
| Rate for Payer: Humana Commercial |
$8,212.70
|
| Rate for Payer: Humana KY Medicaid |
$3,322.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,356.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,922.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,130.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,898.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,389.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,502.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,246.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,932.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,256.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,995.22
|
| Rate for Payer: PHCS Commercial |
$9,275.52
|
| Rate for Payer: United Healthcare All Payer |
$8,502.56
|
|
|
INDIRECT CALORIMETRY TEST
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 94690
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.78
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$166.83
|
| Rate for Payer: First Health Commercial |
$190.95
|
| Rate for Payer: Humana Commercial |
$170.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.88
|
| Rate for Payer: Ohio Health Group HMO |
$150.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.31
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
INDIRECT CALORIMETRY TEST
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 94690
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem Medicaid |
$69.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$166.83
|
| Rate for Payer: First Health Commercial |
$190.95
|
| Rate for Payer: Humana Commercial |
$170.85
|
| Rate for Payer: Humana KY Medicaid |
$69.12
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$69.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.88
|
| Rate for Payer: Ohio Health Group HMO |
$150.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.31
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
INDIUM 111 - IN PENTETREOTIDE
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
34000071
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$183.82 |
| Max. Negotiated Rate |
$1,357.44 |
| Rate for Payer: Aetna Commercial |
$1,088.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,102.92
|
| Rate for Payer: Cash Price |
$707.00
|
| Rate for Payer: Cigna Commercial |
$1,173.62
|
| Rate for Payer: First Health Commercial |
$1,343.30
|
| Rate for Payer: Humana Commercial |
$1,201.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,159.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,043.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$424.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,244.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,060.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$282.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$183.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$438.34
|
| Rate for Payer: PHCS Commercial |
$1,357.44
|
| Rate for Payer: United Healthcare All Payer |
$1,244.32
|
|
