|
BACTRIM DS (SULFAM-TR TAB/1TAB
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
NDC 60687061401
|
| Hospital Charge Code |
25000307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| 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 |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
BACTRIM (SULFAME-TRIMETHO 1TAB
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 57237023201
|
| Hospital Charge Code |
25000306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
|
|
BACTRIM (SULFAME-TRIMETHO 1TAB
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 57237023201
|
| Hospital Charge Code |
25000306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
BACTROBAN (MUPIROCIN) 22 GRAM
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.98
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cigna Commercial |
$3.17
|
| Rate for Payer: First Health Commercial |
$3.63
|
| Rate for Payer: Humana Commercial |
$3.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.36
|
| Rate for Payer: Ohio Health Group HMO |
$2.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.18
|
| Rate for Payer: PHCS Commercial |
$3.67
|
| Rate for Payer: United Healthcare All Payer |
$3.36
|
|
|
BACTROBAN (MUPIROCIN) 22 GRAM
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Anthem Medicaid |
$1.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.98
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cigna Commercial |
$3.17
|
| Rate for Payer: First Health Commercial |
$3.63
|
| Rate for Payer: Humana Commercial |
$3.25
|
| Rate for Payer: Humana KY Medicaid |
$1.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.36
|
| Rate for Payer: Ohio Health Group HMO |
$2.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.18
|
| Rate for Payer: PHCS Commercial |
$3.67
|
| Rate for Payer: United Healthcare All Payer |
$3.36
|
|
|
BAKRI TAMPONADE BALLOON
|
Facility
|
IP
|
$3,228.30
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.68 |
| Max. Negotiated Rate |
$3,099.17 |
| Rate for Payer: Aetna Commercial |
$2,485.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,518.07
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cigna Commercial |
$2,679.49
|
| Rate for Payer: First Health Commercial |
$3,066.88
|
| Rate for Payer: Humana Commercial |
$2,744.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,647.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,382.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$968.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,840.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,421.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.77
|
| Rate for Payer: PHCS Commercial |
$3,099.17
|
| Rate for Payer: United Healthcare All Payer |
$2,840.90
|
|
|
BAKRI TAMPONADE BALLOON
|
Facility
|
OP
|
$3,228.30
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.68 |
| Max. Negotiated Rate |
$3,099.17 |
| Rate for Payer: Aetna Commercial |
$2,485.79
|
| Rate for Payer: Anthem Medicaid |
$1,110.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,518.07
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cigna Commercial |
$2,679.49
|
| Rate for Payer: First Health Commercial |
$3,066.88
|
| Rate for Payer: Humana Commercial |
$2,744.06
|
| Rate for Payer: Humana KY Medicaid |
$1,110.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,121.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,647.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,382.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$968.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,132.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,840.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,421.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.77
|
| Rate for Payer: PHCS Commercial |
$3,099.17
|
| Rate for Payer: United Healthcare All Payer |
$2,840.90
|
|
|
BAL FLUID CELL COUNT
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$5.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$5.60
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
BAL FLUID CELL COUNT
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001545
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
BALLOON 34FR
|
Facility
|
OP
|
$1,835.62
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.63 |
| Max. Negotiated Rate |
$1,762.20 |
| Rate for Payer: Aetna Commercial |
$1,413.43
|
| Rate for Payer: Anthem Medicaid |
$631.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,431.78
|
| Rate for Payer: Cash Price |
$917.81
|
| Rate for Payer: Cigna Commercial |
$1,523.56
|
| Rate for Payer: First Health Commercial |
$1,743.84
|
| Rate for Payer: Humana Commercial |
$1,560.28
|
| Rate for Payer: Humana KY Medicaid |
$631.27
|
| Rate for Payer: Kentucky WC Medicaid |
$637.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,505.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,354.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$550.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$643.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,615.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,376.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$367.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.04
|
| Rate for Payer: PHCS Commercial |
$1,762.20
|
| Rate for Payer: United Healthcare All Payer |
$1,615.35
|
|
|
BALLOON 34FR
|
Facility
|
IP
|
$1,835.62
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.63 |
| Max. Negotiated Rate |
$1,762.20 |
| Rate for Payer: Aetna Commercial |
$1,413.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,431.78
|
| Rate for Payer: Cash Price |
$917.81
|
| Rate for Payer: Cigna Commercial |
$1,523.56
|
| Rate for Payer: First Health Commercial |
$1,743.84
|
| Rate for Payer: Humana Commercial |
$1,560.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,505.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,354.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$550.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,615.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,376.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$367.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.04
|
| Rate for Payer: PHCS Commercial |
$1,762.20
|
| Rate for Payer: United Healthcare All Payer |
$1,615.35
|
|
|
BALLOON 6 X 4
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BALLOON 6 X 4
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BALLOON 9 X 4
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BALLOON 9 X 4
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BALLOON CATH 6215-80
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.36 |
| Max. Negotiated Rate |
$1,509.12 |
| Rate for Payer: Aetna Commercial |
$1,210.44
|
| Rate for Payer: Anthem Medicaid |
$540.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.16
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cigna Commercial |
$1,304.76
|
| Rate for Payer: First Health Commercial |
$1,493.40
|
| Rate for Payer: Humana Commercial |
$1,336.20
|
| Rate for Payer: Humana KY Medicaid |
$540.61
|
| Rate for Payer: Kentucky WC Medicaid |
$546.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$487.32
|
| Rate for Payer: PHCS Commercial |
$1,509.12
|
| Rate for Payer: United Healthcare All Payer |
$1,383.36
|
|
|
BALLOON CATH 6215-80
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.36 |
| Max. Negotiated Rate |
$1,509.12 |
| Rate for Payer: Aetna Commercial |
$1,210.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.16
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cigna Commercial |
$1,304.76
|
| Rate for Payer: First Health Commercial |
$1,493.40
|
| Rate for Payer: Humana Commercial |
$1,336.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$487.32
|
| Rate for Payer: PHCS Commercial |
$1,509.12
|
| Rate for Payer: United Healthcare All Payer |
$1,383.36
|
|
|
BALLOON CATH 6225 ATTAIN CLARI
|
Facility
|
OP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem Medicaid |
$614.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Humana KY Medicaid |
$614.72
|
| Rate for Payer: Kentucky WC Medicaid |
$620.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
BALLOON CATH 6225 ATTAIN CLARI
|
Facility
|
IP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
BALLOON CATHETER 02-0764-00
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Aetna Commercial |
$1,686.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,817.70
|
| Rate for Payer: First Health Commercial |
$2,080.50
|
| Rate for Payer: Humana Commercial |
$1,861.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.90
|
| Rate for Payer: PHCS Commercial |
$2,102.40
|
| Rate for Payer: United Healthcare All Payer |
$1,927.20
|
|
|
BALLOON CATHETER 02-0764-00
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Aetna Commercial |
$1,686.30
|
| Rate for Payer: Anthem Medicaid |
$753.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,817.70
|
| Rate for Payer: First Health Commercial |
$2,080.50
|
| Rate for Payer: Humana Commercial |
$1,861.50
|
| Rate for Payer: Humana KY Medicaid |
$753.14
|
| Rate for Payer: Kentucky WC Medicaid |
$760.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.90
|
| Rate for Payer: PHCS Commercial |
$2,102.40
|
| Rate for Payer: United Healthcare All Payer |
$1,927.20
|
|
|
BALLOON CATHETER B5-2C
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BALLOON CATHETER B5-2C
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BALLOON CATHETER BVCS6180
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
BALLOON CATHETER BVCS6180
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem Medicaid |
$596.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Humana KY Medicaid |
$596.67
|
| Rate for Payer: Kentucky WC Medicaid |
$602.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
