|
INFED IRONDEX 50 MG/100MG/2ML
|
Facility
|
IP
|
$189.82
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
25002161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$182.23 |
| Rate for Payer: Aetna Commercial |
$146.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.06
|
| Rate for Payer: Cash Price |
$94.91
|
| Rate for Payer: Cigna Commercial |
$157.55
|
| Rate for Payer: First Health Commercial |
$180.33
|
| Rate for Payer: Humana Commercial |
$161.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.04
|
| Rate for Payer: Ohio Health Group HMO |
$142.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.98
|
| Rate for Payer: PHCS Commercial |
$182.23
|
| Rate for Payer: United Healthcare All Payer |
$167.04
|
|
|
INFERIOR VENA CAVA LTD
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem Medicaid |
$332.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Humana KY Medicaid |
$332.55
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$335.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.23
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
|
INFERIOR VENA CAVA LTD
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$290.10 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$290.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.23
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
|
INFERIOR VENA CAVA LTD
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$580.20 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Ambetter Exchange |
$55.46
|
| Rate for Payer: Anthem Medicaid |
$63.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.55
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$139.15
|
| Rate for Payer: Healthspan PPO |
$158.56
|
| Rate for Payer: Humana Medicaid |
$63.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.90
|
| Rate for Payer: Molina Healthcare Passport |
$63.63
|
| Rate for Payer: Multiplan PHCS |
$580.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.10
|
| Rate for Payer: UHCCP Medicaid |
$338.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.46
|
|
|
INFERIOR VENA CAVA LTD(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402P0027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$169.22 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Ambetter Exchange |
$55.46
|
| Rate for Payer: Anthem Medicaid |
$63.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.55
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$139.15
|
| Rate for Payer: Healthspan PPO |
$158.56
|
| Rate for Payer: Humana Medicaid |
$63.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.90
|
| Rate for Payer: Molina Healthcare Passport |
$63.63
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.10
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.46
|
|
|
INFERIOR VENA CAVA LTD(T
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402T0027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.98
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
INFERIOR VENA CAVA LTD(T
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402T0027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem Medicaid |
$289.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Humana KY Medicaid |
$289.56
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$292.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.98
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
INFERIOR VENOCAVAGRAM
|
Facility
|
IP
|
$5,060.00
|
|
|
Service Code
|
HCPCS 75825
|
| Hospital Charge Code |
32000167
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,518.00 |
| Max. Negotiated Rate |
$4,857.60 |
| Rate for Payer: Aetna Commercial |
$3,896.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,946.80
|
| Rate for Payer: Cash Price |
$2,530.00
|
| Rate for Payer: Cigna Commercial |
$4,199.80
|
| Rate for Payer: First Health Commercial |
$4,807.00
|
| Rate for Payer: Humana Commercial |
$4,301.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,149.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,734.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,518.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,452.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,048.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,402.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,491.40
|
| Rate for Payer: PHCS Commercial |
$4,857.60
|
| Rate for Payer: United Healthcare All Payer |
$4,452.80
|
|
|
INFERIOR VENOCAVAGRAM
|
Facility
|
OP
|
$5,060.00
|
|
|
Service Code
|
HCPCS 75825
|
| Hospital Charge Code |
32000167
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,740.13 |
| Max. Negotiated Rate |
$4,857.60 |
| Rate for Payer: Aetna Commercial |
$3,896.20
|
| Rate for Payer: Anthem Medicaid |
$1,740.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,946.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,530.00
|
| Rate for Payer: Cash Price |
$2,530.00
|
| Rate for Payer: Cigna Commercial |
$4,199.80
|
| Rate for Payer: First Health Commercial |
$4,807.00
|
| Rate for Payer: Humana Commercial |
$4,301.00
|
| Rate for Payer: Humana KY Medicaid |
$1,740.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,757.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,149.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,734.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,775.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,452.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,048.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,402.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,491.40
|
| Rate for Payer: PHCS Commercial |
$4,857.60
|
| Rate for Payer: United Healthcare All Payer |
$4,452.80
|
|
|
INFERIOR VENOCAVAGRAM
|
Professional
|
Both
|
$5,060.00
|
|
|
Service Code
|
HCPCS 75825
|
| Hospital Charge Code |
32000167
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$3,036.00 |
| Rate for Payer: Aetna Commercial |
$409.27
|
| Rate for Payer: Ambetter Exchange |
$104.69
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.63
|
| Rate for Payer: Cash Price |
$2,530.00
|
| Rate for Payer: Cash Price |
$2,530.00
|
| Rate for Payer: Cigna Commercial |
$676.21
|
| Rate for Payer: Healthspan PPO |
$383.49
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$3,036.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$136.10
|
| Rate for Payer: UHCCP Medicaid |
$1,771.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.69
|
|
|
INFERIOR VENOCAVAGRAM(P
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 75825
|
| Hospital Charge Code |
320P0167
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$676.21 |
| Rate for Payer: Aetna Commercial |
$409.27
|
| Rate for Payer: Ambetter Exchange |
$104.69
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.63
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$676.21
|
| Rate for Payer: Healthspan PPO |
$383.49
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$181.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$136.10
|
| Rate for Payer: UHCCP Medicaid |
$106.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.69
|
|
|
INFERIOR VENOCAVAGRAM(T
|
Facility
|
IP
|
$4,757.00
|
|
|
Service Code
|
HCPCS 75825
|
| Hospital Charge Code |
320T0167
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,427.10 |
| Max. Negotiated Rate |
$4,566.72 |
| Rate for Payer: Aetna Commercial |
$3,662.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,710.46
|
| Rate for Payer: Cash Price |
$2,378.50
|
| Rate for Payer: Cigna Commercial |
$3,948.31
|
| Rate for Payer: First Health Commercial |
$4,519.15
|
| Rate for Payer: Humana Commercial |
$4,043.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,900.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,510.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,427.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,186.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,567.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,805.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,138.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,282.33
|
| Rate for Payer: PHCS Commercial |
$4,566.72
|
| Rate for Payer: United Healthcare All Payer |
$4,186.16
|
|
|
INFERIOR VENOCAVAGRAM(T
|
Facility
|
OP
|
$4,757.00
|
|
|
Service Code
|
HCPCS 75825
|
| Hospital Charge Code |
320T0167
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,635.93 |
| Max. Negotiated Rate |
$4,566.72 |
| Rate for Payer: Aetna Commercial |
$3,662.89
|
| Rate for Payer: Anthem Medicaid |
$1,635.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,710.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,378.50
|
| Rate for Payer: Cash Price |
$2,378.50
|
| Rate for Payer: Cigna Commercial |
$3,948.31
|
| Rate for Payer: First Health Commercial |
$4,519.15
|
| Rate for Payer: Humana Commercial |
$4,043.45
|
| Rate for Payer: Humana KY Medicaid |
$1,635.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,652.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,900.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,510.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,668.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,186.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,567.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,805.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,138.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,282.33
|
| Rate for Payer: PHCS Commercial |
$4,566.72
|
| Rate for Payer: United Healthcare All Payer |
$4,186.16
|
|
|
INFINEON SPLITTER 2*8
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
INFINEON SPLITTER 2*8
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
INFINEON TRIAL LEAD KIT 50CM
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
INFINEON TRIAL LEAD KIT 50CM
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
INFINION 16 LEAD KIT 70CM
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
INFINION 16 LEAD KIT 70CM
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
INFINION CX LEAD KIT 50CM
|
Facility
|
IP
|
$21,500.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,450.00 |
| Max. Negotiated Rate |
$20,640.00 |
| Rate for Payer: Aetna Commercial |
$16,555.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,770.00
|
| Rate for Payer: Cash Price |
$10,750.00
|
| Rate for Payer: Cigna Commercial |
$17,845.00
|
| Rate for Payer: First Health Commercial |
$20,425.00
|
| Rate for Payer: Humana Commercial |
$18,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,630.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,867.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,920.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,705.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,835.00
|
| Rate for Payer: PHCS Commercial |
$20,640.00
|
| Rate for Payer: United Healthcare All Payer |
$18,920.00
|
|
|
INFINION CX LEAD KIT 50CM
|
Facility
|
OP
|
$21,500.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,450.00 |
| Max. Negotiated Rate |
$20,640.00 |
| Rate for Payer: Aetna Commercial |
$16,555.00
|
| Rate for Payer: Anthem Medicaid |
$7,393.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,770.00
|
| Rate for Payer: Cash Price |
$10,750.00
|
| Rate for Payer: Cigna Commercial |
$17,845.00
|
| Rate for Payer: First Health Commercial |
$20,425.00
|
| Rate for Payer: Humana Commercial |
$18,275.00
|
| Rate for Payer: Humana KY Medicaid |
$7,393.85
|
| Rate for Payer: Kentucky WC Medicaid |
$7,469.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,630.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,867.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,542.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,920.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,705.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,835.00
|
| Rate for Payer: PHCS Commercial |
$20,640.00
|
| Rate for Payer: United Healthcare All Payer |
$18,920.00
|
|
|
INFINION CX LEAD KIT 70CM
|
Facility
|
IP
|
$21,500.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,450.00 |
| Max. Negotiated Rate |
$20,640.00 |
| Rate for Payer: Aetna Commercial |
$16,555.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,770.00
|
| Rate for Payer: Cash Price |
$10,750.00
|
| Rate for Payer: Cigna Commercial |
$17,845.00
|
| Rate for Payer: First Health Commercial |
$20,425.00
|
| Rate for Payer: Humana Commercial |
$18,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,630.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,867.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,920.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,705.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,835.00
|
| Rate for Payer: PHCS Commercial |
$20,640.00
|
| Rate for Payer: United Healthcare All Payer |
$18,920.00
|
|
|
INFINION CX LEAD KIT 70CM
|
Facility
|
OP
|
$21,500.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,450.00 |
| Max. Negotiated Rate |
$20,640.00 |
| Rate for Payer: Aetna Commercial |
$16,555.00
|
| Rate for Payer: Anthem Medicaid |
$7,393.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,770.00
|
| Rate for Payer: Cash Price |
$10,750.00
|
| Rate for Payer: Cigna Commercial |
$17,845.00
|
| Rate for Payer: First Health Commercial |
$20,425.00
|
| Rate for Payer: Humana Commercial |
$18,275.00
|
| Rate for Payer: Humana KY Medicaid |
$7,393.85
|
| Rate for Payer: Kentucky WC Medicaid |
$7,469.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,630.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,867.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,542.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,920.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,705.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,835.00
|
| Rate for Payer: PHCS Commercial |
$20,640.00
|
| Rate for Payer: United Healthcare All Payer |
$18,920.00
|
|
|
INFLECTRA 100MG VIAL
|
Facility
|
IP
|
$1,888.28
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
25002726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$566.48 |
| Max. Negotiated Rate |
$1,812.75 |
| Rate for Payer: Aetna Commercial |
$1,453.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.86
|
| Rate for Payer: Cash Price |
$944.14
|
| Rate for Payer: Cigna Commercial |
$1,567.27
|
| Rate for Payer: First Health Commercial |
$1,793.87
|
| Rate for Payer: Humana Commercial |
$1,605.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,393.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,661.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,642.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.91
|
| Rate for Payer: PHCS Commercial |
$1,812.75
|
| Rate for Payer: United Healthcare All Payer |
$1,661.69
|
|
|
INFLECTRA 100MG VIAL
|
Facility
|
OP
|
$1,888.28
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
25002726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$1,812.75 |
| Rate for Payer: Aetna Commercial |
$1,453.98
|
| Rate for Payer: Anthem Medicaid |
$649.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.57
|
| Rate for Payer: Cash Price |
$944.14
|
| Rate for Payer: Cash Price |
$944.14
|
| Rate for Payer: Cigna Commercial |
$1,567.27
|
| Rate for Payer: First Health Commercial |
$1,793.87
|
| Rate for Payer: Humana Commercial |
$1,605.04
|
| Rate for Payer: Humana KY Medicaid |
$649.38
|
| Rate for Payer: Humana Medicare Advantage |
$19.68
|
| Rate for Payer: Kentucky WC Medicaid |
$655.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,393.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,661.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,642.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.91
|
| Rate for Payer: PHCS Commercial |
$1,812.75
|
| Rate for Payer: United Healthcare All Payer |
$1,661.69
|
|
