|
INDERAL (PROPRANOLOL 20MG/1TAB
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 60687059801
|
| Hospital Charge Code |
25000776
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.47 |
| 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
|
| 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 |
$3.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
|
|
INDERAL (PROPRANOLOL 20MG/1TAB
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 60687059801
|
| Hospital Charge Code |
25000776
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| 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 |
$3.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
|
|
INDIGO 3 W/TUBING
|
Facility
|
OP
|
$8,577.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,573.16 |
| Max. Negotiated Rate |
$8,234.11 |
| Rate for Payer: Aetna Commercial |
$6,604.44
|
| Rate for Payer: Anthem Medicaid |
$2,949.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.22
|
| Rate for Payer: Cash Price |
$4,288.60
|
| Rate for Payer: Cigna Commercial |
$7,119.08
|
| Rate for Payer: First Health Commercial |
$8,148.34
|
| Rate for Payer: Humana Commercial |
$7,290.62
|
| Rate for Payer: Humana KY Medicaid |
$2,949.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,462.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,918.27
|
| Rate for Payer: PHCS Commercial |
$8,234.11
|
| Rate for Payer: United Healthcare All Payer |
$7,547.94
|
|
|
INDIGO 3 W/TUBING
|
Facility
|
IP
|
$8,577.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,573.16 |
| Max. Negotiated Rate |
$8,234.11 |
| Rate for Payer: Aetna Commercial |
$6,604.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.22
|
| Rate for Payer: Cash Price |
$4,288.60
|
| Rate for Payer: Cigna Commercial |
$7,119.08
|
| Rate for Payer: First Health Commercial |
$8,148.34
|
| Rate for Payer: Humana Commercial |
$7,290.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,462.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,918.27
|
| Rate for Payer: PHCS Commercial |
$8,234.11
|
| Rate for Payer: United Healthcare All Payer |
$7,547.94
|
|
|
INDIGO 5 W/TUBING
|
Facility
|
OP
|
$8,577.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,573.16 |
| Max. Negotiated Rate |
$8,234.11 |
| Rate for Payer: Aetna Commercial |
$6,604.44
|
| Rate for Payer: Anthem Medicaid |
$2,949.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.22
|
| Rate for Payer: Cash Price |
$4,288.60
|
| Rate for Payer: Cigna Commercial |
$7,119.08
|
| Rate for Payer: First Health Commercial |
$8,148.34
|
| Rate for Payer: Humana Commercial |
$7,290.62
|
| Rate for Payer: Humana KY Medicaid |
$2,949.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,462.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,918.27
|
| Rate for Payer: PHCS Commercial |
$8,234.11
|
| Rate for Payer: United Healthcare All Payer |
$7,547.94
|
|
|
INDIGO 5 W/TUBING
|
Facility
|
IP
|
$8,577.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,573.16 |
| Max. Negotiated Rate |
$8,234.11 |
| Rate for Payer: Aetna Commercial |
$6,604.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.22
|
| Rate for Payer: Cash Price |
$4,288.60
|
| Rate for Payer: Cigna Commercial |
$7,119.08
|
| Rate for Payer: First Health Commercial |
$8,148.34
|
| Rate for Payer: Humana Commercial |
$7,290.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,462.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,918.27
|
| Rate for Payer: PHCS Commercial |
$8,234.11
|
| Rate for Payer: United Healthcare All Payer |
$7,547.94
|
|
|
INDIGO 6 W/TUBING
|
Facility
|
IP
|
$11,775.85
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,532.76 |
| Max. Negotiated Rate |
$11,304.82 |
| Rate for Payer: Aetna Commercial |
$9,067.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,185.16
|
| Rate for Payer: Cash Price |
$5,887.92
|
| Rate for Payer: Cigna Commercial |
$9,773.96
|
| Rate for Payer: First Health Commercial |
$11,187.06
|
| Rate for Payer: Humana Commercial |
$10,009.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,690.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,532.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,362.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,831.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,420.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,244.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,125.34
|
| Rate for Payer: PHCS Commercial |
$11,304.82
|
| Rate for Payer: United Healthcare All Payer |
$10,362.75
|
|
|
INDIGO 6 W/TUBING
|
Facility
|
OP
|
$11,775.85
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,532.76 |
| Max. Negotiated Rate |
$11,304.82 |
| Rate for Payer: Aetna Commercial |
$9,067.40
|
| Rate for Payer: Anthem Medicaid |
$4,049.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,185.16
|
| Rate for Payer: Cash Price |
$5,887.92
|
| Rate for Payer: Cigna Commercial |
$9,773.96
|
| Rate for Payer: First Health Commercial |
$11,187.06
|
| Rate for Payer: Humana Commercial |
$10,009.47
|
| Rate for Payer: Humana KY Medicaid |
$4,049.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,090.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,690.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,532.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,130.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,362.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,831.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,420.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,244.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,125.34
|
| Rate for Payer: PHCS Commercial |
$11,304.82
|
| Rate for Payer: United Healthcare All Payer |
$10,362.75
|
|
|
INDIGO 7D XTORQ + DYNAMIC
|
Facility
|
IP
|
$13,372.30
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,011.69 |
| Max. Negotiated Rate |
$12,837.41 |
| Rate for Payer: Aetna Commercial |
$10,296.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,430.39
|
| Rate for Payer: Cash Price |
$6,686.15
|
| Rate for Payer: Cigna Commercial |
$11,099.01
|
| Rate for Payer: First Health Commercial |
$12,703.68
|
| Rate for Payer: Humana Commercial |
$11,366.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,965.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,868.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,011.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,767.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,029.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,697.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,633.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,226.89
|
| Rate for Payer: PHCS Commercial |
$12,837.41
|
| Rate for Payer: United Healthcare All Payer |
$11,767.62
|
|
|
INDIGO 7D XTORQ + DYNAMIC
|
Facility
|
OP
|
$13,372.30
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,011.69 |
| Max. Negotiated Rate |
$12,837.41 |
| Rate for Payer: Aetna Commercial |
$10,296.67
|
| Rate for Payer: Anthem Medicaid |
$4,598.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,430.39
|
| Rate for Payer: Cash Price |
$6,686.15
|
| Rate for Payer: Cigna Commercial |
$11,099.01
|
| Rate for Payer: First Health Commercial |
$12,703.68
|
| Rate for Payer: Humana Commercial |
$11,366.45
|
| Rate for Payer: Humana KY Medicaid |
$4,598.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,645.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,965.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,868.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,011.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,691.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,767.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,029.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,697.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,633.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,226.89
|
| Rate for Payer: PHCS Commercial |
$12,837.41
|
| Rate for Payer: United Healthcare All Payer |
$11,767.62
|
|
|
INDIGO 8 ST TIP W/TUBING
|
Facility
|
OP
|
$16,443.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,933.05 |
| Max. Negotiated Rate |
$15,785.76 |
| Rate for Payer: Aetna Commercial |
$12,661.50
|
| Rate for Payer: Anthem Medicaid |
$5,654.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,825.93
|
| Rate for Payer: Cash Price |
$8,221.75
|
| Rate for Payer: Cigna Commercial |
$13,648.10
|
| Rate for Payer: First Health Commercial |
$15,621.33
|
| Rate for Payer: Humana Commercial |
$13,976.98
|
| Rate for Payer: Humana KY Medicaid |
$5,654.92
|
| Rate for Payer: Kentucky WC Medicaid |
$5,712.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,483.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,135.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,933.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,768.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,470.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,332.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,154.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,305.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,346.01
|
| Rate for Payer: PHCS Commercial |
$15,785.76
|
| Rate for Payer: United Healthcare All Payer |
$14,470.28
|
|
|
INDIGO 8 ST TIP W/TUBING
|
Facility
|
IP
|
$16,443.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,933.05 |
| Max. Negotiated Rate |
$15,785.76 |
| Rate for Payer: Aetna Commercial |
$12,661.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,825.93
|
| Rate for Payer: Cash Price |
$8,221.75
|
| Rate for Payer: Cigna Commercial |
$13,648.10
|
| Rate for Payer: First Health Commercial |
$15,621.33
|
| Rate for Payer: Humana Commercial |
$13,976.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,483.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,135.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,933.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,470.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,332.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,154.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,305.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,346.01
|
| Rate for Payer: PHCS Commercial |
$15,785.76
|
| Rate for Payer: United Healthcare All Payer |
$14,470.28
|
|
|
INDIGO 8 TORQ TIP W/TUBING
|
Facility
|
OP
|
$16,443.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,933.05 |
| Max. Negotiated Rate |
$15,785.76 |
| Rate for Payer: Aetna Commercial |
$12,661.50
|
| Rate for Payer: Anthem Medicaid |
$5,654.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,825.93
|
| Rate for Payer: Cash Price |
$8,221.75
|
| Rate for Payer: Cigna Commercial |
$13,648.10
|
| Rate for Payer: First Health Commercial |
$15,621.33
|
| Rate for Payer: Humana Commercial |
$13,976.98
|
| Rate for Payer: Humana KY Medicaid |
$5,654.92
|
| Rate for Payer: Kentucky WC Medicaid |
$5,712.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,483.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,135.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,933.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,768.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,470.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,332.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,154.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,305.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,346.01
|
| Rate for Payer: PHCS Commercial |
$15,785.76
|
| Rate for Payer: United Healthcare All Payer |
$14,470.28
|
|
|
INDIGO 8 TORQ TIP W/TUBING
|
Facility
|
IP
|
$16,443.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,933.05 |
| Max. Negotiated Rate |
$15,785.76 |
| Rate for Payer: Aetna Commercial |
$12,661.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,825.93
|
| Rate for Payer: Cash Price |
$8,221.75
|
| Rate for Payer: Cigna Commercial |
$13,648.10
|
| Rate for Payer: First Health Commercial |
$15,621.33
|
| Rate for Payer: Humana Commercial |
$13,976.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,483.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,135.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,933.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,470.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,332.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,154.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,305.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,346.01
|
| Rate for Payer: PHCS Commercial |
$15,785.76
|
| Rate for Payer: United Healthcare All Payer |
$14,470.28
|
|
|
INDIGO 8 XTORQ TIP W/TUBING
|
Facility
|
IP
|
$16,443.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,933.05 |
| Max. Negotiated Rate |
$15,785.76 |
| Rate for Payer: Aetna Commercial |
$12,661.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,825.93
|
| Rate for Payer: Cash Price |
$8,221.75
|
| Rate for Payer: Cigna Commercial |
$13,648.10
|
| Rate for Payer: First Health Commercial |
$15,621.33
|
| Rate for Payer: Humana Commercial |
$13,976.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,483.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,135.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,933.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,470.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,332.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,154.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,305.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,346.01
|
| Rate for Payer: PHCS Commercial |
$15,785.76
|
| Rate for Payer: United Healthcare All Payer |
$14,470.28
|
|
|
INDIGO 8 XTORQ TIP W/TUBING
|
Facility
|
OP
|
$16,443.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,933.05 |
| Max. Negotiated Rate |
$15,785.76 |
| Rate for Payer: Aetna Commercial |
$12,661.50
|
| Rate for Payer: Anthem Medicaid |
$5,654.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,825.93
|
| Rate for Payer: Cash Price |
$8,221.75
|
| Rate for Payer: Cigna Commercial |
$13,648.10
|
| Rate for Payer: First Health Commercial |
$15,621.33
|
| Rate for Payer: Humana Commercial |
$13,976.98
|
| Rate for Payer: Humana KY Medicaid |
$5,654.92
|
| Rate for Payer: Kentucky WC Medicaid |
$5,712.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,483.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,135.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,933.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,768.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,470.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,332.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,154.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,305.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,346.01
|
| Rate for Payer: PHCS Commercial |
$15,785.76
|
| Rate for Payer: United Healthcare All Payer |
$14,470.28
|
|
|
INDIGO ASPIRATION TUBING
|
Facility
|
IP
|
$3,642.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,092.75 |
| Max. Negotiated Rate |
$3,496.80 |
| Rate for Payer: Aetna Commercial |
$2,804.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,841.15
|
| Rate for Payer: Cash Price |
$1,821.25
|
| Rate for Payer: Cigna Commercial |
$3,023.28
|
| Rate for Payer: First Health Commercial |
$3,460.38
|
| Rate for Payer: Humana Commercial |
$3,096.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,986.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,688.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,092.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,205.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,731.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,914.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,168.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.32
|
| Rate for Payer: PHCS Commercial |
$3,496.80
|
| Rate for Payer: United Healthcare All Payer |
$3,205.40
|
|
|
INDIGO ASPIRATION TUBING
|
Facility
|
OP
|
$3,642.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,092.75 |
| Max. Negotiated Rate |
$3,496.80 |
| Rate for Payer: Aetna Commercial |
$2,804.72
|
| Rate for Payer: Anthem Medicaid |
$1,252.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,841.15
|
| Rate for Payer: Cash Price |
$1,821.25
|
| Rate for Payer: Cigna Commercial |
$3,023.28
|
| Rate for Payer: First Health Commercial |
$3,460.38
|
| Rate for Payer: Humana Commercial |
$3,096.12
|
| Rate for Payer: Humana KY Medicaid |
$1,252.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,265.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,986.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,688.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,092.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,277.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,205.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,731.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,914.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,168.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.32
|
| Rate for Payer: PHCS Commercial |
$3,496.80
|
| Rate for Payer: United Healthcare All Payer |
$3,205.40
|
|
|
INDIGO CATH
|
Facility
|
OP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem Medicaid |
$3,466.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Humana KY Medicaid |
$3,466.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
INDIGO CATH
|
Facility
|
IP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
INDIGO CATH 12+ LIGHTNING
|
Facility
|
OP
|
$30,537.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,161.25 |
| Max. Negotiated Rate |
$29,316.00 |
| Rate for Payer: Aetna Commercial |
$23,513.88
|
| Rate for Payer: Anthem Medicaid |
$10,501.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,819.25
|
| Rate for Payer: Cash Price |
$15,268.75
|
| Rate for Payer: Cigna Commercial |
$25,346.12
|
| Rate for Payer: First Health Commercial |
$29,010.62
|
| Rate for Payer: Humana Commercial |
$25,956.88
|
| Rate for Payer: Humana KY Medicaid |
$10,501.85
|
| Rate for Payer: Kentucky WC Medicaid |
$10,608.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,040.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,536.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,161.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,712.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,873.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,903.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,567.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,070.88
|
| Rate for Payer: PHCS Commercial |
$29,316.00
|
| Rate for Payer: United Healthcare All Payer |
$26,873.00
|
|
|
INDIGO CATH 12+ LIGHTNING
|
Facility
|
IP
|
$30,537.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,161.25 |
| Max. Negotiated Rate |
$29,316.00 |
| Rate for Payer: Aetna Commercial |
$23,513.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,819.25
|
| Rate for Payer: Cash Price |
$15,268.75
|
| Rate for Payer: Cigna Commercial |
$25,346.12
|
| Rate for Payer: First Health Commercial |
$29,010.62
|
| Rate for Payer: Humana Commercial |
$25,956.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,040.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,536.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,161.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,873.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,903.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,567.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,070.88
|
| Rate for Payer: PHCS Commercial |
$29,316.00
|
| Rate for Payer: United Healthcare All Payer |
$26,873.00
|
|
|
INDIGO CATH 3
|
Facility
|
IP
|
$7,244.95
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,173.49 |
| Max. Negotiated Rate |
$6,955.15 |
| Rate for Payer: Aetna Commercial |
$5,578.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,651.06
|
| Rate for Payer: Cash Price |
$3,622.48
|
| Rate for Payer: Cigna Commercial |
$6,013.31
|
| Rate for Payer: First Health Commercial |
$6,882.70
|
| Rate for Payer: Humana Commercial |
$6,158.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,940.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,346.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,173.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,375.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,433.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,795.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,303.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.02
|
| Rate for Payer: PHCS Commercial |
$6,955.15
|
| Rate for Payer: United Healthcare All Payer |
$6,375.56
|
|
|
INDIGO CATH 3
|
Facility
|
OP
|
$7,244.95
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,173.49 |
| Max. Negotiated Rate |
$6,955.15 |
| Rate for Payer: Aetna Commercial |
$5,578.61
|
| Rate for Payer: Anthem Medicaid |
$2,491.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,651.06
|
| Rate for Payer: Cash Price |
$3,622.48
|
| Rate for Payer: Cigna Commercial |
$6,013.31
|
| Rate for Payer: First Health Commercial |
$6,882.70
|
| Rate for Payer: Humana Commercial |
$6,158.21
|
| Rate for Payer: Humana KY Medicaid |
$2,491.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,516.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,940.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,346.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,173.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,541.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,375.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,433.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,795.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,303.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.02
|
| Rate for Payer: PHCS Commercial |
$6,955.15
|
| Rate for Payer: United Healthcare All Payer |
$6,375.56
|
|
|
INDIGO CATH 5
|
Facility
|
OP
|
$7,244.95
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,173.49 |
| Max. Negotiated Rate |
$6,955.15 |
| Rate for Payer: Aetna Commercial |
$5,578.61
|
| Rate for Payer: Anthem Medicaid |
$2,491.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,651.06
|
| Rate for Payer: Cash Price |
$3,622.48
|
| Rate for Payer: Cigna Commercial |
$6,013.31
|
| Rate for Payer: First Health Commercial |
$6,882.70
|
| Rate for Payer: Humana Commercial |
$6,158.21
|
| Rate for Payer: Humana KY Medicaid |
$2,491.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,516.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,940.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,346.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,173.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,541.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,375.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,433.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,795.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,303.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.02
|
| Rate for Payer: PHCS Commercial |
$6,955.15
|
| Rate for Payer: United Healthcare All Payer |
$6,375.56
|
|
