|
NATRELLE TISSUE EXPNDRS 700 CC
|
Facility
|
IP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
NATRELLE TISSUE EXPNDRS 700 CC
|
Facility
|
OP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
NAV 6 FILTER 5.0
|
Facility
|
IP
|
$8,000.50
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,400.15 |
| Max. Negotiated Rate |
$7,680.48 |
| Rate for Payer: Aetna Commercial |
$6,160.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.39
|
| Rate for Payer: Cash Price |
$4,000.25
|
| Rate for Payer: Cigna Commercial |
$6,640.41
|
| Rate for Payer: First Health Commercial |
$7,600.48
|
| Rate for Payer: Humana Commercial |
$6,800.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,560.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,040.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,400.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,960.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,520.35
|
| Rate for Payer: PHCS Commercial |
$7,680.48
|
| Rate for Payer: United Healthcare All Payer |
$7,040.44
|
|
|
NAV 6 FILTER 5.0
|
Facility
|
OP
|
$8,000.50
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,400.15 |
| Max. Negotiated Rate |
$7,680.48 |
| Rate for Payer: Aetna Commercial |
$6,160.39
|
| Rate for Payer: Anthem Medicaid |
$2,751.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.39
|
| Rate for Payer: Cash Price |
$4,000.25
|
| Rate for Payer: Cigna Commercial |
$6,640.41
|
| Rate for Payer: First Health Commercial |
$7,600.48
|
| Rate for Payer: Humana Commercial |
$6,800.43
|
| Rate for Payer: Humana KY Medicaid |
$2,751.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,779.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,560.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,806.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,040.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,400.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,960.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,520.35
|
| Rate for Payer: PHCS Commercial |
$7,680.48
|
| Rate for Payer: United Healthcare All Payer |
$7,040.44
|
|
|
NAV 6 FILTER 7.2
|
Facility
|
IP
|
$8,000.50
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,400.15 |
| Max. Negotiated Rate |
$7,680.48 |
| Rate for Payer: Aetna Commercial |
$6,160.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.39
|
| Rate for Payer: Cash Price |
$4,000.25
|
| Rate for Payer: Cigna Commercial |
$6,640.41
|
| Rate for Payer: First Health Commercial |
$7,600.48
|
| Rate for Payer: Humana Commercial |
$6,800.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,560.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,040.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,400.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,960.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,520.35
|
| Rate for Payer: PHCS Commercial |
$7,680.48
|
| Rate for Payer: United Healthcare All Payer |
$7,040.44
|
|
|
NAV 6 FILTER 7.2
|
Facility
|
OP
|
$8,000.50
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,400.15 |
| Max. Negotiated Rate |
$7,680.48 |
| Rate for Payer: Aetna Commercial |
$6,160.39
|
| Rate for Payer: Anthem Medicaid |
$2,751.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.39
|
| Rate for Payer: Cash Price |
$4,000.25
|
| Rate for Payer: Cigna Commercial |
$6,640.41
|
| Rate for Payer: First Health Commercial |
$7,600.48
|
| Rate for Payer: Humana Commercial |
$6,800.43
|
| Rate for Payer: Humana KY Medicaid |
$2,751.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,779.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,560.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,806.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,040.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,400.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,960.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,520.35
|
| Rate for Payer: PHCS Commercial |
$7,680.48
|
| Rate for Payer: United Healthcare All Payer |
$7,040.44
|
|
|
NAVANE (THIOTHIXENE) 1MG/1CAP
|
Facility
|
IP
|
$5.15
|
|
|
Service Code
|
NDC 70954001410
|
| Hospital Charge Code |
25001055
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| 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 |
$4.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.55
|
| 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 |
$1.54 |
| 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 |
$4.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.55
|
| Rate for Payer: PHCS Commercial |
$4.94
|
| Rate for Payer: United Healthcare All Payer |
$4.53
|
|
|
NAVANE (THIOTHIXENE) 5MG/1CAP
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 70954001610
|
| Hospital Charge Code |
25001056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| 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 |
$7.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.84
|
| Rate for Payer: PHCS Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Payer |
$8.72
|
|
|
NAVANE (THIOTHIXENE) 5MG/1CAP
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 70954001610
|
| Hospital Charge Code |
25001056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| 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 |
$7.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.84
|
| Rate for Payer: PHCS Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Payer |
$8.72
|
|
|
NAVICROSS .035 150CM STR
|
Facility
|
OP
|
$1,949.80
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$584.94 |
| Max. Negotiated Rate |
$1,871.81 |
| Rate for Payer: Aetna Commercial |
$1,501.35
|
| Rate for Payer: Anthem Medicaid |
$670.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.84
|
| Rate for Payer: Cash Price |
$974.90
|
| Rate for Payer: Cigna Commercial |
$1,618.33
|
| Rate for Payer: First Health Commercial |
$1,852.31
|
| Rate for Payer: Humana Commercial |
$1,657.33
|
| Rate for Payer: Humana KY Medicaid |
$670.54
|
| Rate for Payer: Kentucky WC Medicaid |
$677.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,559.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.36
|
| Rate for Payer: PHCS Commercial |
$1,871.81
|
| Rate for Payer: United Healthcare All Payer |
$1,715.82
|
|
|
NAVICROSS .035 150CM STR
|
Facility
|
IP
|
$1,949.80
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$584.94 |
| Max. Negotiated Rate |
$1,871.81 |
| Rate for Payer: Aetna Commercial |
$1,501.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.84
|
| Rate for Payer: Cash Price |
$974.90
|
| Rate for Payer: Cigna Commercial |
$1,618.33
|
| Rate for Payer: First Health Commercial |
$1,852.31
|
| Rate for Payer: Humana Commercial |
$1,657.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,559.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.36
|
| Rate for Payer: PHCS Commercial |
$1,871.81
|
| Rate for Payer: United Healthcare All Payer |
$1,715.82
|
|
|
NAVICROSS ANGLED 90CM
|
Facility
|
OP
|
$1,949.80
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$584.94 |
| Max. Negotiated Rate |
$1,871.81 |
| Rate for Payer: Aetna Commercial |
$1,501.35
|
| Rate for Payer: Anthem Medicaid |
$670.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.84
|
| Rate for Payer: Cash Price |
$974.90
|
| Rate for Payer: Cigna Commercial |
$1,618.33
|
| Rate for Payer: First Health Commercial |
$1,852.31
|
| Rate for Payer: Humana Commercial |
$1,657.33
|
| Rate for Payer: Humana KY Medicaid |
$670.54
|
| Rate for Payer: Kentucky WC Medicaid |
$677.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,559.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.36
|
| Rate for Payer: PHCS Commercial |
$1,871.81
|
| Rate for Payer: United Healthcare All Payer |
$1,715.82
|
|
|
NAVICROSS ANGLED 90CM
|
Facility
|
IP
|
$1,949.80
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$584.94 |
| Max. Negotiated Rate |
$1,871.81 |
| Rate for Payer: Aetna Commercial |
$1,501.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.84
|
| Rate for Payer: Cash Price |
$974.90
|
| Rate for Payer: Cigna Commercial |
$1,618.33
|
| Rate for Payer: First Health Commercial |
$1,852.31
|
| Rate for Payer: Humana Commercial |
$1,657.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,559.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.36
|
| Rate for Payer: PHCS Commercial |
$1,871.81
|
| Rate for Payer: United Healthcare All Payer |
$1,715.82
|
|
|
NAVIG ACCESS SHEATH 12/14F*36C
|
Facility
|
OP
|
$1,770.90
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.27 |
| Max. Negotiated Rate |
$1,700.06 |
| Rate for Payer: Aetna Commercial |
$1,363.59
|
| Rate for Payer: Anthem Medicaid |
$609.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.30
|
| Rate for Payer: Cash Price |
$885.45
|
| Rate for Payer: Cigna Commercial |
$1,469.85
|
| Rate for Payer: First Health Commercial |
$1,682.36
|
| Rate for Payer: Humana Commercial |
$1,505.27
|
| Rate for Payer: Humana KY Medicaid |
$609.01
|
| Rate for Payer: Kentucky WC Medicaid |
$615.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,221.92
|
| Rate for Payer: PHCS Commercial |
$1,700.06
|
| Rate for Payer: United Healthcare All Payer |
$1,558.39
|
|
|
NAVIG ACCESS SHEATH 12/14F*36C
|
Facility
|
IP
|
$1,770.90
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.27 |
| Max. Negotiated Rate |
$1,700.06 |
| Rate for Payer: Aetna Commercial |
$1,363.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.30
|
| Rate for Payer: Cash Price |
$885.45
|
| Rate for Payer: Cigna Commercial |
$1,469.85
|
| Rate for Payer: First Health Commercial |
$1,682.36
|
| Rate for Payer: Humana Commercial |
$1,505.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,221.92
|
| Rate for Payer: PHCS Commercial |
$1,700.06
|
| Rate for Payer: United Healthcare All Payer |
$1,558.39
|
|
|
NAVIG ACCESS SHEATH 12/14F*46C
|
Facility
|
IP
|
$1,770.90
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.27 |
| Max. Negotiated Rate |
$1,700.06 |
| Rate for Payer: Aetna Commercial |
$1,363.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.30
|
| Rate for Payer: Cash Price |
$885.45
|
| Rate for Payer: Cigna Commercial |
$1,469.85
|
| Rate for Payer: First Health Commercial |
$1,682.36
|
| Rate for Payer: Humana Commercial |
$1,505.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,221.92
|
| Rate for Payer: PHCS Commercial |
$1,700.06
|
| Rate for Payer: United Healthcare All Payer |
$1,558.39
|
|
|
NAVIG ACCESS SHEATH 12/14F*46C
|
Facility
|
OP
|
$1,770.90
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.27 |
| Max. Negotiated Rate |
$1,700.06 |
| Rate for Payer: Aetna Commercial |
$1,363.59
|
| Rate for Payer: Anthem Medicaid |
$609.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.30
|
| Rate for Payer: Cash Price |
$885.45
|
| Rate for Payer: Cigna Commercial |
$1,469.85
|
| Rate for Payer: First Health Commercial |
$1,682.36
|
| Rate for Payer: Humana Commercial |
$1,505.27
|
| Rate for Payer: Humana KY Medicaid |
$609.01
|
| Rate for Payer: Kentucky WC Medicaid |
$615.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,221.92
|
| Rate for Payer: PHCS Commercial |
$1,700.06
|
| Rate for Payer: United Healthcare All Payer |
$1,558.39
|
|
|
NAVIGATIONAL BRONCHOSCOPY
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 31627
|
| Hospital Charge Code |
41000039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$1,153.55 |
| Rate for Payer: Aetna Commercial |
$174.58
|
| Rate for Payer: Ambetter Exchange |
$89.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.80
|
| Rate for Payer: Anthem Medicaid |
$829.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.58
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$168.85
|
| Rate for Payer: Healthspan PPO |
$1,153.55
|
| Rate for Payer: Humana Medicaid |
$829.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$846.30
|
| Rate for Payer: Molina Healthcare Passport |
$829.71
|
| Rate for Payer: Multiplan PHCS |
$999.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.55
|
| Rate for Payer: UHCCP Medicaid |
$51.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$838.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.65
|
|
|
NAVIGATIONAL BRONCHOSCOPY
|
Facility
|
IP
|
$1,665.00
|
|
|
Service Code
|
HCPCS 31627
|
| Hospital Charge Code |
41000039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$499.50 |
| Max. Negotiated Rate |
$1,598.40 |
| Rate for Payer: Aetna Commercial |
$1,282.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,298.70
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$1,381.95
|
| Rate for Payer: First Health Commercial |
$1,581.75
|
| Rate for Payer: Humana Commercial |
$1,415.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,365.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,228.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$499.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,465.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,248.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,448.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,148.85
|
| Rate for Payer: PHCS Commercial |
$1,598.40
|
| Rate for Payer: United Healthcare All Payer |
$1,465.20
|
|
|
NAVIGATIONAL BRONCHOSCOPY
|
Facility
|
OP
|
$1,665.00
|
|
|
Service Code
|
HCPCS 31627
|
| Hospital Charge Code |
41000039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$499.50 |
| Max. Negotiated Rate |
$1,598.40 |
| Rate for Payer: Aetna Commercial |
$1,282.05
|
| Rate for Payer: Anthem Medicaid |
$572.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,298.70
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$1,381.95
|
| Rate for Payer: First Health Commercial |
$1,581.75
|
| Rate for Payer: Humana Commercial |
$1,415.25
|
| Rate for Payer: Humana KY Medicaid |
$572.59
|
| Rate for Payer: Kentucky WC Medicaid |
$578.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,365.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,228.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$499.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$584.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,465.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,248.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,448.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,148.85
|
| Rate for Payer: PHCS Commercial |
$1,598.40
|
| Rate for Payer: United Healthcare All Payer |
$1,465.20
|
|
|
NAVIGATIONAL BRONCHOSCOPY(P
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 31627
|
| Hospital Charge Code |
410P0039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$1,153.55 |
| Rate for Payer: Aetna Commercial |
$174.58
|
| Rate for Payer: Ambetter Exchange |
$89.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.80
|
| Rate for Payer: Anthem Medicaid |
$829.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.58
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$168.85
|
| Rate for Payer: Healthspan PPO |
$1,153.55
|
| Rate for Payer: Humana Medicaid |
$829.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$846.30
|
| Rate for Payer: Molina Healthcare Passport |
$829.71
|
| Rate for Payer: Multiplan PHCS |
$999.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.55
|
| Rate for Payer: UHCCP Medicaid |
$51.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$838.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.65
|
|
|
N BLOCK INJ BRACHIAL PLEXUS
|
Facility
|
IP
|
$2,470.77
|
|
|
Service Code
|
HCPCS 64415
|
| Hospital Charge Code |
76102312
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$741.23 |
| Max. Negotiated Rate |
$2,371.94 |
| Rate for Payer: Aetna Commercial |
$1,902.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,927.20
|
| Rate for Payer: Cash Price |
$1,235.38
|
| Rate for Payer: Cigna Commercial |
$2,050.74
|
| Rate for Payer: First Health Commercial |
$2,347.23
|
| Rate for Payer: Humana Commercial |
$2,100.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,026.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,823.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$741.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,174.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,853.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,149.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,704.83
|
| Rate for Payer: PHCS Commercial |
$2,371.94
|
| Rate for Payer: United Healthcare All Payer |
$2,174.28
|
|
|
N BLOCK INJ BRACHIAL PLEXUS
|
Professional
|
Both
|
$2,470.77
|
|
|
Service Code
|
HCPCS 64415
|
| Hospital Charge Code |
76102312
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$1,482.46 |
| Rate for Payer: Aetna Commercial |
$119.44
|
| Rate for Payer: Ambetter Exchange |
$66.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.84
|
| Rate for Payer: Anthem Medicaid |
$87.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$66.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.34
|
| Rate for Payer: Cash Price |
$1,235.38
|
| Rate for Payer: Cash Price |
$1,235.38
|
| Rate for Payer: Cigna Commercial |
$112.01
|
| Rate for Payer: Healthspan PPO |
$156.45
|
| Rate for Payer: Humana Medicaid |
$87.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$66.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.55
|
| Rate for Payer: Molina Healthcare Passport |
$87.79
|
| Rate for Payer: Multiplan PHCS |
$1,482.46
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.96
|
| Rate for Payer: UHCCP Medicaid |
$33.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$66.12
|
|
|
N BLOCK INJ BRACHIAL PLEXUS
|
Facility
|
OP
|
$2,470.77
|
|
|
Service Code
|
HCPCS 64415
|
| Hospital Charge Code |
76102312
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.61 |
| Max. Negotiated Rate |
$2,371.94 |
| Rate for Payer: Aetna Commercial |
$1,902.49
|
| Rate for Payer: Anthem Medicaid |
$849.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,927.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,151.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,110.52
|
| Rate for Payer: Cash Price |
$1,235.38
|
| Rate for Payer: Cash Price |
$1,235.38
|
| Rate for Payer: Cigna Commercial |
$2,050.74
|
| Rate for Payer: First Health Commercial |
$2,347.23
|
| Rate for Payer: Humana Commercial |
$2,100.15
|
| Rate for Payer: Humana KY Medicaid |
$849.70
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$858.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,026.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,823.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$866.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,174.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,853.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,149.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,704.83
|
| Rate for Payer: PHCS Commercial |
$2,371.94
|
| Rate for Payer: United Healthcare All Payer |
$2,174.28
|
|
