|
LONGEVITY LINER NEUT 54JJ 36
|
Facility
|
OP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem Medicaid |
$2,581.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Humana KY Medicaid |
$2,581.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,633.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LONG OPTION 100CM FILTER
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
LONG OPTION 100CM FILTER
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
LONITEN (MINOXIDIL) 10MG/1TAB
|
Facility
|
IP
|
$4.84
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
25000903
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna Commercial |
$4.02
|
| Rate for Payer: First Health Commercial |
$4.60
|
| Rate for Payer: Humana Commercial |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.26
|
| Rate for Payer: Ohio Health Group HMO |
$3.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.34
|
| Rate for Payer: PHCS Commercial |
$4.65
|
| Rate for Payer: United Healthcare All Payer |
$4.26
|
|
|
LONITEN (MINOXIDIL) 10MG/1TAB
|
Facility
|
OP
|
$4.84
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
25000903
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Anthem Medicaid |
$1.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna Commercial |
$4.02
|
| Rate for Payer: First Health Commercial |
$4.60
|
| Rate for Payer: Humana Commercial |
$4.11
|
| Rate for Payer: Humana KY Medicaid |
$1.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.26
|
| Rate for Payer: Ohio Health Group HMO |
$3.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.34
|
| Rate for Payer: PHCS Commercial |
$4.65
|
| Rate for Payer: United Healthcare All Payer |
$4.26
|
|
|
LONITEN (MINOXIDIL) 2.5MG/1TAB
|
Facility
|
IP
|
$4.72
|
|
|
Service Code
|
NDC 68084020401
|
| Hospital Charge Code |
25000904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna Commercial |
$3.92
|
| Rate for Payer: First Health Commercial |
$4.48
|
| Rate for Payer: Humana Commercial |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.15
|
| Rate for Payer: Ohio Health Group HMO |
$3.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.26
|
| Rate for Payer: PHCS Commercial |
$4.53
|
| Rate for Payer: United Healthcare All Payer |
$4.15
|
|
|
LONITEN (MINOXIDIL) 2.5MG/1TAB
|
Facility
|
OP
|
$4.72
|
|
|
Service Code
|
NDC 68084020401
|
| Hospital Charge Code |
25000904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Anthem Medicaid |
$1.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna Commercial |
$3.92
|
| Rate for Payer: First Health Commercial |
$4.48
|
| Rate for Payer: Humana Commercial |
$4.01
|
| Rate for Payer: Humana KY Medicaid |
$1.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.15
|
| Rate for Payer: Ohio Health Group HMO |
$3.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.26
|
| Rate for Payer: PHCS Commercial |
$4.53
|
| Rate for Payer: United Healthcare All Payer |
$4.15
|
|
|
LOOP N TAK KNOTLESS KIT
|
Facility
|
IP
|
$5,386.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.88 |
| Max. Negotiated Rate |
$5,170.80 |
| Rate for Payer: Aetna Commercial |
$4,147.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,201.27
|
| Rate for Payer: Cash Price |
$2,693.12
|
| Rate for Payer: Cigna Commercial |
$4,470.59
|
| Rate for Payer: First Health Commercial |
$5,116.94
|
| Rate for Payer: Humana Commercial |
$4,578.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,416.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,975.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,615.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,739.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,039.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,309.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,686.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,716.51
|
| Rate for Payer: PHCS Commercial |
$5,170.80
|
| Rate for Payer: United Healthcare All Payer |
$4,739.90
|
|
|
LOOP N TAK KNOTLESS KIT
|
Facility
|
OP
|
$5,386.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.88 |
| Max. Negotiated Rate |
$5,170.80 |
| Rate for Payer: Aetna Commercial |
$4,147.41
|
| Rate for Payer: Anthem Medicaid |
$1,852.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,201.27
|
| Rate for Payer: Cash Price |
$2,693.12
|
| Rate for Payer: Cigna Commercial |
$4,470.59
|
| Rate for Payer: First Health Commercial |
$5,116.94
|
| Rate for Payer: Humana Commercial |
$4,578.31
|
| Rate for Payer: Humana KY Medicaid |
$1,852.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,871.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,416.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,975.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,615.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,889.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,739.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,039.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,309.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,686.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,716.51
|
| Rate for Payer: PHCS Commercial |
$5,170.80
|
| Rate for Payer: United Healthcare All Payer |
$4,739.90
|
|
|
LOOP ORGAN DONATION
|
Facility
|
IP
|
$4,542.00
|
|
| Hospital Charge Code |
36001287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,362.60 |
| Max. Negotiated Rate |
$4,360.32 |
| Rate for Payer: Aetna Commercial |
$3,497.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,542.76
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$3,769.86
|
| Rate for Payer: First Health Commercial |
$4,314.90
|
| Rate for Payer: Humana Commercial |
$3,860.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,724.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,352.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,362.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,996.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,133.98
|
| Rate for Payer: PHCS Commercial |
$4,360.32
|
| Rate for Payer: United Healthcare All Payer |
$3,996.96
|
|
|
LOOP ORGAN DONATION
|
Facility
|
OP
|
$4,542.00
|
|
| Hospital Charge Code |
36001287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,362.60 |
| Max. Negotiated Rate |
$4,360.32 |
| Rate for Payer: Aetna Commercial |
$3,497.34
|
| Rate for Payer: Anthem Medicaid |
$1,561.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,542.76
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$3,769.86
|
| Rate for Payer: First Health Commercial |
$4,314.90
|
| Rate for Payer: Humana Commercial |
$3,860.70
|
| Rate for Payer: Humana KY Medicaid |
$1,561.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,577.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,724.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,352.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,362.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,593.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,996.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,133.98
|
| Rate for Payer: PHCS Commercial |
$4,360.32
|
| Rate for Payer: United Healthcare All Payer |
$3,996.96
|
|
|
LOOP RECORDER INSERTABLE
|
Facility
|
OP
|
$16,591.50
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,977.45 |
| Max. Negotiated Rate |
$15,927.84 |
| Rate for Payer: Aetna Commercial |
$12,775.45
|
| Rate for Payer: Anthem Medicaid |
$5,705.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,941.37
|
| Rate for Payer: Cash Price |
$8,295.75
|
| Rate for Payer: Cigna Commercial |
$13,770.94
|
| Rate for Payer: First Health Commercial |
$15,761.92
|
| Rate for Payer: Humana Commercial |
$14,102.77
|
| Rate for Payer: Humana KY Medicaid |
$5,705.82
|
| Rate for Payer: Kentucky WC Medicaid |
$5,763.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,605.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,244.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,977.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,820.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,600.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,273.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,434.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,448.14
|
| Rate for Payer: PHCS Commercial |
$15,927.84
|
| Rate for Payer: United Healthcare All Payer |
$14,600.52
|
|
|
LOOP RECORDER INSERTABLE
|
Facility
|
IP
|
$16,591.50
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,977.45 |
| Max. Negotiated Rate |
$15,927.84 |
| Rate for Payer: Aetna Commercial |
$12,775.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,941.37
|
| Rate for Payer: Cash Price |
$8,295.75
|
| Rate for Payer: Cigna Commercial |
$13,770.94
|
| Rate for Payer: First Health Commercial |
$15,761.92
|
| Rate for Payer: Humana Commercial |
$14,102.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,605.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,244.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,977.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,600.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,273.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,434.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,448.14
|
| Rate for Payer: PHCS Commercial |
$15,927.84
|
| Rate for Payer: United Healthcare All Payer |
$14,600.52
|
|
|
LOOP RECORDER REVEAL LINQ
|
Facility
|
IP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
LOOP RECORDER REVEAL LINQ
|
Facility
|
OP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem Medicaid |
$7,522.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Humana KY Medicaid |
$7,522.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,599.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,673.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
LOOP RECORDER REVEAL LINQ II
|
Facility
|
OP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem Medicaid |
$7,522.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Humana KY Medicaid |
$7,522.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,599.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,673.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
LOOP RECORDER REVEAL LINQ II
|
Facility
|
IP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
LOOP RECORDER REVEAL XT 9529
|
Facility
|
OP
|
$18,626.50
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,587.95 |
| Max. Negotiated Rate |
$17,881.44 |
| Rate for Payer: Aetna Commercial |
$14,342.41
|
| Rate for Payer: Anthem Medicaid |
$6,405.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,528.67
|
| Rate for Payer: Cash Price |
$9,313.25
|
| Rate for Payer: Cigna Commercial |
$15,460.00
|
| Rate for Payer: First Health Commercial |
$17,695.17
|
| Rate for Payer: Humana Commercial |
$15,832.52
|
| Rate for Payer: Humana KY Medicaid |
$6,405.65
|
| Rate for Payer: Kentucky WC Medicaid |
$6,470.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,273.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,746.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,587.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,534.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,391.32
|
| Rate for Payer: Ohio Health Group HMO |
$13,969.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,901.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,205.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,852.28
|
| Rate for Payer: PHCS Commercial |
$17,881.44
|
| Rate for Payer: United Healthcare All Payer |
$16,391.32
|
|
|
LOOP RECORDER REVEAL XT 9529
|
Facility
|
IP
|
$18,626.50
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,587.95 |
| Max. Negotiated Rate |
$17,881.44 |
| Rate for Payer: Aetna Commercial |
$14,342.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,528.67
|
| Rate for Payer: Cash Price |
$9,313.25
|
| Rate for Payer: Cigna Commercial |
$15,460.00
|
| Rate for Payer: First Health Commercial |
$17,695.17
|
| Rate for Payer: Humana Commercial |
$15,832.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,273.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,746.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,587.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,391.32
|
| Rate for Payer: Ohio Health Group HMO |
$13,969.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,901.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,205.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,852.28
|
| Rate for Payer: PHCS Commercial |
$17,881.44
|
| Rate for Payer: United Healthcare All Payer |
$16,391.32
|
|
|
LOPID (GEMFIBROZIL) 600MG/1TAB
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
25000905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.70
|
| Rate for Payer: First Health Commercial |
$4.24
|
| Rate for Payer: Humana Commercial |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
LOPID (GEMFIBROZIL) 600MG/1TAB
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
25000905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.70
|
| Rate for Payer: First Health Commercial |
$4.24
|
| Rate for Payer: Humana Commercial |
$3.79
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
LOPRESSOR (METOPROLO 25MG/1TAB
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 62584026501
|
| Hospital Charge Code |
25000906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
LOPRESSOR (METOPROLO 25MG/1TAB
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 62584026501
|
| Hospital Charge Code |
25000906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
LOPRESSOR (METOPROLO 50MG/1TAB
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 62584026601
|
| Hospital Charge Code |
25000907
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
LOPRESSOR (METOPROLO 50MG/1TAB
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 62584026601
|
| Hospital Charge Code |
25000907
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
