|
NASOPHARYNX BX(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 42804
|
| Hospital Charge Code |
761P1700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$163.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.56
|
| Rate for Payer: Anthem Medicaid |
$67.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$167.06
|
| Rate for Payer: Healthspan PPO |
$229.84
|
| Rate for Payer: Humana Medicaid |
$67.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.66
|
| Rate for Payer: Molina Healthcare Passport |
$67.31
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$77.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.98
|
|
|
NASOPHARYNX BX(T
|
Facility
|
OP
|
$3,774.36
|
|
|
Service Code
|
HCPCS 42804
|
| Hospital Charge Code |
761T1700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.67 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$2,906.26
|
| Rate for Payer: Anthem Medicaid |
$1,298.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$1,887.18
|
| Rate for Payer: Cash Price |
$1,887.18
|
| Rate for Payer: Cigna Commercial |
$3,132.72
|
| Rate for Payer: First Health Commercial |
$3,585.64
|
| Rate for Payer: Humana Commercial |
$3,208.21
|
| Rate for Payer: Humana KY Medicaid |
$1,298.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,094.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,321.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,830.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$754.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.05
|
| Rate for Payer: PHCS Commercial |
$3,623.39
|
| Rate for Payer: United Healthcare All Payer |
$3,321.44
|
|
|
NASOPHARYNX BX(T
|
Facility
|
IP
|
$3,774.36
|
|
|
Service Code
|
HCPCS 42804
|
| Hospital Charge Code |
761T1700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.67 |
| Max. Negotiated Rate |
$3,623.39 |
| Rate for Payer: Aetna Commercial |
$2,906.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.00
|
| Rate for Payer: Cash Price |
$1,887.18
|
| Rate for Payer: Cigna Commercial |
$3,132.72
|
| Rate for Payer: First Health Commercial |
$3,585.64
|
| Rate for Payer: Humana Commercial |
$3,208.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,094.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,321.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,830.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$754.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.05
|
| Rate for Payer: PHCS Commercial |
$3,623.39
|
| Rate for Payer: United Healthcare All Payer |
$3,321.44
|
|
|
NATRELLE 410 BRST IMP LH 310CC
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
NATRELLE 410 BRST IMP LH 310CC
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
NATRELLE TISSUE EXPNDRS 700 CC
|
Facility
|
OP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem Medicaid |
$2,657.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Humana KY Medicaid |
$2,657.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
NATRELLE TISSUE EXPNDRS 700 CC
|
Facility
|
IP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
NAV 6 FILTER 5.0
|
Facility
|
OP
|
$7,800.50
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,014.06 |
| Max. Negotiated Rate |
$7,488.48 |
| Rate for Payer: Aetna Commercial |
$6,006.38
|
| Rate for Payer: Anthem Medicaid |
$2,682.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,084.39
|
| Rate for Payer: Cash Price |
$3,900.25
|
| Rate for Payer: Cigna Commercial |
$6,474.42
|
| Rate for Payer: First Health Commercial |
$7,410.48
|
| Rate for Payer: Humana Commercial |
$6,630.42
|
| Rate for Payer: Humana KY Medicaid |
$2,682.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,709.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,396.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,756.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,340.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,736.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,864.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,850.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.16
|
| Rate for Payer: PHCS Commercial |
$7,488.48
|
| Rate for Payer: United Healthcare All Payer |
$6,864.44
|
|
|
NAV 6 FILTER 5.0
|
Facility
|
IP
|
$7,800.50
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,014.06 |
| Max. Negotiated Rate |
$7,488.48 |
| Rate for Payer: Aetna Commercial |
$6,006.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,084.39
|
| Rate for Payer: Cash Price |
$3,900.25
|
| Rate for Payer: Cigna Commercial |
$6,474.42
|
| Rate for Payer: First Health Commercial |
$7,410.48
|
| Rate for Payer: Humana Commercial |
$6,630.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,396.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,756.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,340.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,864.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,850.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.16
|
| Rate for Payer: PHCS Commercial |
$7,488.48
|
| Rate for Payer: United Healthcare All Payer |
$6,864.44
|
|
|
NAV 6 FILTER 7.2
|
Facility
|
IP
|
$7,800.50
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,014.06 |
| Max. Negotiated Rate |
$7,488.48 |
| Rate for Payer: Aetna Commercial |
$6,006.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,084.39
|
| Rate for Payer: Cash Price |
$3,900.25
|
| Rate for Payer: Cigna Commercial |
$6,474.42
|
| Rate for Payer: First Health Commercial |
$7,410.48
|
| Rate for Payer: Humana Commercial |
$6,630.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,396.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,756.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,340.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,864.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,850.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.16
|
| Rate for Payer: PHCS Commercial |
$7,488.48
|
| Rate for Payer: United Healthcare All Payer |
$6,864.44
|
|
|
NAV 6 FILTER 7.2
|
Facility
|
OP
|
$7,800.50
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,014.06 |
| Max. Negotiated Rate |
$7,488.48 |
| Rate for Payer: Aetna Commercial |
$6,006.38
|
| Rate for Payer: Anthem Medicaid |
$2,682.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,084.39
|
| Rate for Payer: Cash Price |
$3,900.25
|
| Rate for Payer: Cigna Commercial |
$6,474.42
|
| Rate for Payer: First Health Commercial |
$7,410.48
|
| Rate for Payer: Humana Commercial |
$6,630.42
|
| Rate for Payer: Humana KY Medicaid |
$2,682.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,709.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,396.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,756.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,340.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,736.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,864.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,850.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.16
|
| Rate for Payer: PHCS Commercial |
$7,488.48
|
| Rate for Payer: United Healthcare All Payer |
$6,864.44
|
|
|
NAVANE (THIOTHIXENE) 1MG/1CAP
|
Facility
|
IP
|
$5.15
|
|
|
Service Code
|
NDC 70954001410
|
| Hospital Charge Code |
25001055
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$3.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.02
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.27
|
| Rate for Payer: First Health Commercial |
$4.89
|
| Rate for Payer: Humana Commercial |
$4.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.53
|
| Rate for Payer: Ohio Health Group HMO |
$3.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.60
|
| Rate for Payer: PHCS Commercial |
$4.94
|
| Rate for Payer: United Healthcare All Payer |
$4.53
|
|
|
NAVANE (THIOTHIXENE) 1MG/1CAP
|
Facility
|
OP
|
$5.15
|
|
|
Service Code
|
NDC 70954001410
|
| Hospital Charge Code |
25001055
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$3.97
|
| Rate for Payer: Anthem Medicaid |
$1.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.02
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.27
|
| Rate for Payer: First Health Commercial |
$4.89
|
| Rate for Payer: Humana Commercial |
$4.38
|
| Rate for Payer: Humana KY Medicaid |
$1.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.53
|
| Rate for Payer: Ohio Health Group HMO |
$3.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.60
|
| Rate for Payer: PHCS Commercial |
$4.94
|
| Rate for Payer: United Healthcare All Payer |
$4.53
|
|
|
NAVANE (THIOTHIXENE) 5MG/1CAP
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 70954001610
|
| Hospital Charge Code |
25001056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.73
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cigna Commercial |
$8.23
|
| Rate for Payer: First Health Commercial |
$9.41
|
| Rate for Payer: Humana Commercial |
$8.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.72
|
| Rate for Payer: Ohio Health Group HMO |
$7.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.07
|
| Rate for Payer: PHCS Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Payer |
$8.72
|
|
|
NAVANE (THIOTHIXENE) 5MG/1CAP
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 70954001610
|
| Hospital Charge Code |
25001056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: Anthem Medicaid |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.73
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cigna Commercial |
$8.23
|
| Rate for Payer: First Health Commercial |
$9.41
|
| Rate for Payer: Humana Commercial |
$8.42
|
| Rate for Payer: Humana KY Medicaid |
$3.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.72
|
| Rate for Payer: Ohio Health Group HMO |
$7.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.07
|
| Rate for Payer: PHCS Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Payer |
$8.72
|
|
|
NAVICROSS .035 150CM ANGLE
|
Facility
|
IP
|
$1,948.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,870.56 |
| Rate for Payer: Aetna Commercial |
$1,500.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.83
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cigna Commercial |
$1,617.26
|
| Rate for Payer: First Health Commercial |
$1,851.08
|
| Rate for Payer: Humana Commercial |
$1,656.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,437.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.04
|
| Rate for Payer: PHCS Commercial |
$1,870.56
|
| Rate for Payer: United Healthcare All Payer |
$1,714.68
|
|
|
NAVICROSS .035 150CM ANGLE
|
Facility
|
OP
|
$1,948.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,870.56 |
| Rate for Payer: Aetna Commercial |
$1,500.34
|
| Rate for Payer: Anthem Medicaid |
$670.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.83
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cigna Commercial |
$1,617.26
|
| Rate for Payer: First Health Commercial |
$1,851.08
|
| Rate for Payer: Humana Commercial |
$1,656.22
|
| Rate for Payer: Humana KY Medicaid |
$670.09
|
| Rate for Payer: Kentucky WC Medicaid |
$676.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,437.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.04
|
| Rate for Payer: PHCS Commercial |
$1,870.56
|
| Rate for Payer: United Healthcare All Payer |
$1,714.68
|
|
|
NAVICROSS .035 150CM STR
|
Facility
|
OP
|
$1,948.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,870.56 |
| Rate for Payer: Aetna Commercial |
$1,500.34
|
| Rate for Payer: Anthem Medicaid |
$670.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.83
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cigna Commercial |
$1,617.26
|
| Rate for Payer: First Health Commercial |
$1,851.08
|
| Rate for Payer: Humana Commercial |
$1,656.22
|
| Rate for Payer: Humana KY Medicaid |
$670.09
|
| Rate for Payer: Kentucky WC Medicaid |
$676.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,437.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.04
|
| Rate for Payer: PHCS Commercial |
$1,870.56
|
| Rate for Payer: United Healthcare All Payer |
$1,714.68
|
|
|
NAVICROSS .035 150CM STR
|
Facility
|
IP
|
$1,948.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,870.56 |
| Rate for Payer: Aetna Commercial |
$1,500.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.83
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cigna Commercial |
$1,617.26
|
| Rate for Payer: First Health Commercial |
$1,851.08
|
| Rate for Payer: Humana Commercial |
$1,656.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,437.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.04
|
| Rate for Payer: PHCS Commercial |
$1,870.56
|
| Rate for Payer: United Healthcare All Payer |
$1,714.68
|
|
|
NAVICROSS ANGLED 90CM
|
Facility
|
OP
|
$1,948.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,870.56 |
| Rate for Payer: Aetna Commercial |
$1,500.34
|
| Rate for Payer: Anthem Medicaid |
$670.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.83
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cigna Commercial |
$1,617.26
|
| Rate for Payer: First Health Commercial |
$1,851.08
|
| Rate for Payer: Humana Commercial |
$1,656.22
|
| Rate for Payer: Humana KY Medicaid |
$670.09
|
| Rate for Payer: Kentucky WC Medicaid |
$676.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,437.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.04
|
| Rate for Payer: PHCS Commercial |
$1,870.56
|
| Rate for Payer: United Healthcare All Payer |
$1,714.68
|
|
|
NAVICROSS ANGLED 90CM
|
Facility
|
IP
|
$1,948.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,870.56 |
| Rate for Payer: Aetna Commercial |
$1,500.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.83
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cigna Commercial |
$1,617.26
|
| Rate for Payer: First Health Commercial |
$1,851.08
|
| Rate for Payer: Humana Commercial |
$1,656.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,437.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.04
|
| Rate for Payer: PHCS Commercial |
$1,870.56
|
| Rate for Payer: United Healthcare All Payer |
$1,714.68
|
|
|
NAVICROSS ST 90CM
|
Facility
|
OP
|
$1,948.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,870.56 |
| Rate for Payer: Aetna Commercial |
$1,500.34
|
| Rate for Payer: Anthem Medicaid |
$670.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.83
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cigna Commercial |
$1,617.26
|
| Rate for Payer: First Health Commercial |
$1,851.08
|
| Rate for Payer: Humana Commercial |
$1,656.22
|
| Rate for Payer: Humana KY Medicaid |
$670.09
|
| Rate for Payer: Kentucky WC Medicaid |
$676.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,437.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.04
|
| Rate for Payer: PHCS Commercial |
$1,870.56
|
| Rate for Payer: United Healthcare All Payer |
$1,714.68
|
|
|
NAVICROSS ST 90CM
|
Facility
|
IP
|
$1,948.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,870.56 |
| Rate for Payer: Aetna Commercial |
$1,500.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.83
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cigna Commercial |
$1,617.26
|
| Rate for Payer: First Health Commercial |
$1,851.08
|
| Rate for Payer: Humana Commercial |
$1,656.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,437.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.04
|
| Rate for Payer: PHCS Commercial |
$1,870.56
|
| Rate for Payer: United Healthcare All Payer |
$1,714.68
|
|
|
NAVIG ACCESS SHEATH 12/14F*36C
|
Facility
|
IP
|
$1,783.72
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.88 |
| Max. Negotiated Rate |
$1,712.37 |
| Rate for Payer: Aetna Commercial |
$1,373.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,391.30
|
| Rate for Payer: Cash Price |
$891.86
|
| Rate for Payer: Cigna Commercial |
$1,480.49
|
| Rate for Payer: First Health Commercial |
$1,694.53
|
| Rate for Payer: Humana Commercial |
$1,516.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,316.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,337.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.95
|
| Rate for Payer: PHCS Commercial |
$1,712.37
|
| Rate for Payer: United Healthcare All Payer |
$1,569.67
|
|
|
NAVIG ACCESS SHEATH 12/14F*36C
|
Facility
|
OP
|
$1,783.72
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.88 |
| Max. Negotiated Rate |
$1,712.37 |
| Rate for Payer: Aetna Commercial |
$1,373.46
|
| Rate for Payer: Anthem Medicaid |
$613.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,391.30
|
| Rate for Payer: Cash Price |
$891.86
|
| Rate for Payer: Cigna Commercial |
$1,480.49
|
| Rate for Payer: First Health Commercial |
$1,694.53
|
| Rate for Payer: Humana Commercial |
$1,516.16
|
| Rate for Payer: Humana KY Medicaid |
$613.42
|
| Rate for Payer: Kentucky WC Medicaid |
$619.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,316.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,337.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.95
|
| Rate for Payer: PHCS Commercial |
$1,712.37
|
| Rate for Payer: United Healthcare All Payer |
$1,569.67
|
|
