|
TAKERU RX NC BALLOON 3.25*15
|
Facility
|
IP
|
$1,721.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.54 |
| Max. Negotiated Rate |
$1,652.93 |
| Rate for Payer: Aetna Commercial |
$1,325.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.00
|
| Rate for Payer: Cash Price |
$860.90
|
| Rate for Payer: Cigna Commercial |
$1,429.09
|
| Rate for Payer: First Health Commercial |
$1,635.71
|
| Rate for Payer: Humana Commercial |
$1,463.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,515.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,291.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.04
|
| Rate for Payer: PHCS Commercial |
$1,652.93
|
| Rate for Payer: United Healthcare All Payer |
$1,515.18
|
|
|
TAKERU RX NC BALLOON 3.25*21
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TAKERU RX NC BALLOON 3.25*21
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TAKERU RX NC BALLOON 3.25*8
|
Facility
|
IP
|
$1,721.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.54 |
| Max. Negotiated Rate |
$1,652.93 |
| Rate for Payer: Aetna Commercial |
$1,325.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.00
|
| Rate for Payer: Cash Price |
$860.90
|
| Rate for Payer: Cigna Commercial |
$1,429.09
|
| Rate for Payer: First Health Commercial |
$1,635.71
|
| Rate for Payer: Humana Commercial |
$1,463.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,515.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,291.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.04
|
| Rate for Payer: PHCS Commercial |
$1,652.93
|
| Rate for Payer: United Healthcare All Payer |
$1,515.18
|
|
|
TAKERU RX NC BALLOON 3.25*8
|
Facility
|
OP
|
$1,721.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.54 |
| Max. Negotiated Rate |
$1,652.93 |
| Rate for Payer: Aetna Commercial |
$1,325.79
|
| Rate for Payer: Anthem Medicaid |
$592.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.00
|
| Rate for Payer: Cash Price |
$860.90
|
| Rate for Payer: Cigna Commercial |
$1,429.09
|
| Rate for Payer: First Health Commercial |
$1,635.71
|
| Rate for Payer: Humana Commercial |
$1,463.53
|
| Rate for Payer: Humana KY Medicaid |
$592.13
|
| Rate for Payer: Kentucky WC Medicaid |
$598.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,515.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,291.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.04
|
| Rate for Payer: PHCS Commercial |
$1,652.93
|
| Rate for Payer: United Healthcare All Payer |
$1,515.18
|
|
|
TAKERU RX NC BALLOON 3.50*8
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem Medicaid |
$597.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Humana KY Medicaid |
$597.35
|
| Rate for Payer: Kentucky WC Medicaid |
$603.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
TAKERU RX NC BALLOON 3.50*8
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
TAKERU RX NC BALLOON 3.5*12
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
TAKERU RX NC BALLOON 3.5*12
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem Medicaid |
$597.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Humana KY Medicaid |
$597.35
|
| Rate for Payer: Kentucky WC Medicaid |
$603.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
TAKERU RX NC BALLOON 3.5*15
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
TAKERU RX NC BALLOON 3.5*15
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem Medicaid |
$597.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Humana KY Medicaid |
$597.35
|
| Rate for Payer: Kentucky WC Medicaid |
$603.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
TAKERU RX NC BALLOON 3.5*21
|
Facility
|
OP
|
$2,001.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.33 |
| Max. Negotiated Rate |
$1,921.06 |
| Rate for Payer: Aetna Commercial |
$1,540.85
|
| Rate for Payer: Anthem Medicaid |
$688.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.86
|
| Rate for Payer: Cash Price |
$1,000.55
|
| Rate for Payer: Cigna Commercial |
$1,660.91
|
| Rate for Payer: First Health Commercial |
$1,901.05
|
| Rate for Payer: Humana Commercial |
$1,700.93
|
| Rate for Payer: Humana KY Medicaid |
$688.18
|
| Rate for Payer: Kentucky WC Medicaid |
$695.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.76
|
| Rate for Payer: PHCS Commercial |
$1,921.06
|
| Rate for Payer: United Healthcare All Payer |
$1,760.97
|
|
|
TAKERU RX NC BALLOON 3.5*21
|
Facility
|
IP
|
$2,001.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.33 |
| Max. Negotiated Rate |
$1,921.06 |
| Rate for Payer: Aetna Commercial |
$1,540.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.86
|
| Rate for Payer: Cash Price |
$1,000.55
|
| Rate for Payer: Cigna Commercial |
$1,660.91
|
| Rate for Payer: First Health Commercial |
$1,901.05
|
| Rate for Payer: Humana Commercial |
$1,700.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.76
|
| Rate for Payer: PHCS Commercial |
$1,921.06
|
| Rate for Payer: United Healthcare All Payer |
$1,760.97
|
|
|
TAKERU RX NC BALLOON 3*8
|
Facility
|
IP
|
$1,721.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.54 |
| Max. Negotiated Rate |
$1,652.93 |
| Rate for Payer: Aetna Commercial |
$1,325.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.00
|
| Rate for Payer: Cash Price |
$860.90
|
| Rate for Payer: Cigna Commercial |
$1,429.09
|
| Rate for Payer: First Health Commercial |
$1,635.71
|
| Rate for Payer: Humana Commercial |
$1,463.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,515.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,291.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.04
|
| Rate for Payer: PHCS Commercial |
$1,652.93
|
| Rate for Payer: United Healthcare All Payer |
$1,515.18
|
|
|
TAKERU RX NC BALLOON 3*8
|
Facility
|
OP
|
$1,721.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.54 |
| Max. Negotiated Rate |
$1,652.93 |
| Rate for Payer: Aetna Commercial |
$1,325.79
|
| Rate for Payer: Anthem Medicaid |
$592.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.00
|
| Rate for Payer: Cash Price |
$860.90
|
| Rate for Payer: Cigna Commercial |
$1,429.09
|
| Rate for Payer: First Health Commercial |
$1,635.71
|
| Rate for Payer: Humana Commercial |
$1,463.53
|
| Rate for Payer: Humana KY Medicaid |
$592.13
|
| Rate for Payer: Kentucky WC Medicaid |
$598.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,515.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,291.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.04
|
| Rate for Payer: PHCS Commercial |
$1,652.93
|
| Rate for Payer: United Healthcare All Payer |
$1,515.18
|
|
|
TAKERU RX NC BALLOON 4*12
|
Facility
|
IP
|
$2,001.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.33 |
| Max. Negotiated Rate |
$1,921.06 |
| Rate for Payer: Aetna Commercial |
$1,540.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.86
|
| Rate for Payer: Cash Price |
$1,000.55
|
| Rate for Payer: Cigna Commercial |
$1,660.91
|
| Rate for Payer: First Health Commercial |
$1,901.05
|
| Rate for Payer: Humana Commercial |
$1,700.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.76
|
| Rate for Payer: PHCS Commercial |
$1,921.06
|
| Rate for Payer: United Healthcare All Payer |
$1,760.97
|
|
|
TAKERU RX NC BALLOON 4*12
|
Facility
|
OP
|
$2,001.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.33 |
| Max. Negotiated Rate |
$1,921.06 |
| Rate for Payer: Aetna Commercial |
$1,540.85
|
| Rate for Payer: Anthem Medicaid |
$688.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.86
|
| Rate for Payer: Cash Price |
$1,000.55
|
| Rate for Payer: Cigna Commercial |
$1,660.91
|
| Rate for Payer: First Health Commercial |
$1,901.05
|
| Rate for Payer: Humana Commercial |
$1,700.93
|
| Rate for Payer: Humana KY Medicaid |
$688.18
|
| Rate for Payer: Kentucky WC Medicaid |
$695.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.76
|
| Rate for Payer: PHCS Commercial |
$1,921.06
|
| Rate for Payer: United Healthcare All Payer |
$1,760.97
|
|
|
TAKERU RX NC BALLOON 4*15
|
Facility
|
IP
|
$2,001.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.33 |
| Max. Negotiated Rate |
$1,921.06 |
| Rate for Payer: Aetna Commercial |
$1,540.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.86
|
| Rate for Payer: Cash Price |
$1,000.55
|
| Rate for Payer: Cigna Commercial |
$1,660.91
|
| Rate for Payer: First Health Commercial |
$1,901.05
|
| Rate for Payer: Humana Commercial |
$1,700.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.76
|
| Rate for Payer: PHCS Commercial |
$1,921.06
|
| Rate for Payer: United Healthcare All Payer |
$1,760.97
|
|
|
TAKERU RX NC BALLOON 4*15
|
Facility
|
OP
|
$2,001.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.33 |
| Max. Negotiated Rate |
$1,921.06 |
| Rate for Payer: Aetna Commercial |
$1,540.85
|
| Rate for Payer: Anthem Medicaid |
$688.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.86
|
| Rate for Payer: Cash Price |
$1,000.55
|
| Rate for Payer: Cigna Commercial |
$1,660.91
|
| Rate for Payer: First Health Commercial |
$1,901.05
|
| Rate for Payer: Humana Commercial |
$1,700.93
|
| Rate for Payer: Humana KY Medicaid |
$688.18
|
| Rate for Payer: Kentucky WC Medicaid |
$695.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.76
|
| Rate for Payer: PHCS Commercial |
$1,921.06
|
| Rate for Payer: United Healthcare All Payer |
$1,760.97
|
|
|
TAKERU RX NC BALLOON 4*21
|
Facility
|
OP
|
$2,001.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.33 |
| Max. Negotiated Rate |
$1,921.06 |
| Rate for Payer: Aetna Commercial |
$1,540.85
|
| Rate for Payer: Anthem Medicaid |
$688.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.86
|
| Rate for Payer: Cash Price |
$1,000.55
|
| Rate for Payer: Cigna Commercial |
$1,660.91
|
| Rate for Payer: First Health Commercial |
$1,901.05
|
| Rate for Payer: Humana Commercial |
$1,700.93
|
| Rate for Payer: Humana KY Medicaid |
$688.18
|
| Rate for Payer: Kentucky WC Medicaid |
$695.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.76
|
| Rate for Payer: PHCS Commercial |
$1,921.06
|
| Rate for Payer: United Healthcare All Payer |
$1,760.97
|
|
|
TAKERU RX NC BALLOON 4*21
|
Facility
|
IP
|
$2,001.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.33 |
| Max. Negotiated Rate |
$1,921.06 |
| Rate for Payer: Aetna Commercial |
$1,540.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.86
|
| Rate for Payer: Cash Price |
$1,000.55
|
| Rate for Payer: Cigna Commercial |
$1,660.91
|
| Rate for Payer: First Health Commercial |
$1,901.05
|
| Rate for Payer: Humana Commercial |
$1,700.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.76
|
| Rate for Payer: PHCS Commercial |
$1,921.06
|
| Rate for Payer: United Healthcare All Payer |
$1,760.97
|
|
|
TAKERU RX NC BALLOON 4*8
|
Facility
|
IP
|
$1,721.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.54 |
| Max. Negotiated Rate |
$1,652.93 |
| Rate for Payer: Aetna Commercial |
$1,325.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.00
|
| Rate for Payer: Cash Price |
$860.90
|
| Rate for Payer: Cigna Commercial |
$1,429.09
|
| Rate for Payer: First Health Commercial |
$1,635.71
|
| Rate for Payer: Humana Commercial |
$1,463.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,515.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,291.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.04
|
| Rate for Payer: PHCS Commercial |
$1,652.93
|
| Rate for Payer: United Healthcare All Payer |
$1,515.18
|
|
|
TAKERU RX NC BALLOON 4*8
|
Facility
|
OP
|
$1,721.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.54 |
| Max. Negotiated Rate |
$1,652.93 |
| Rate for Payer: Aetna Commercial |
$1,325.79
|
| Rate for Payer: Anthem Medicaid |
$592.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.00
|
| Rate for Payer: Cash Price |
$860.90
|
| Rate for Payer: Cigna Commercial |
$1,429.09
|
| Rate for Payer: First Health Commercial |
$1,635.71
|
| Rate for Payer: Humana Commercial |
$1,463.53
|
| Rate for Payer: Humana KY Medicaid |
$592.13
|
| Rate for Payer: Kentucky WC Medicaid |
$598.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,515.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,291.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.04
|
| Rate for Payer: PHCS Commercial |
$1,652.93
|
| Rate for Payer: United Healthcare All Payer |
$1,515.18
|
|
|
TAMBOCOR(FLECAINIDE) 50MG TAB
|
Facility
|
IP
|
$4.77
|
|
|
Service Code
|
NDC 54001020
|
| Hospital Charge Code |
25001484
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.96
|
| Rate for Payer: First Health Commercial |
$4.53
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.20
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.29
|
| Rate for Payer: PHCS Commercial |
$4.58
|
| Rate for Payer: United Healthcare All Payer |
$4.20
|
|
|
TAMBOCOR(FLECAINIDE) 50MG TAB
|
Facility
|
OP
|
$4.77
|
|
|
Service Code
|
NDC 54001020
|
| Hospital Charge Code |
25001484
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.96
|
| Rate for Payer: First Health Commercial |
$4.53
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.20
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.29
|
| Rate for Payer: PHCS Commercial |
$4.58
|
| Rate for Payer: United Healthcare All Payer |
$4.20
|
|
