|
VERAPAMIL IC KIT
|
Facility
|
IP
|
$191.50
|
|
|
Service Code
|
NDC 70069027105
|
| Hospital Charge Code |
25003568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$183.84 |
| Rate for Payer: Aetna Commercial |
$147.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.37
|
| Rate for Payer: Cash Price |
$95.75
|
| Rate for Payer: Cigna Commercial |
$158.94
|
| Rate for Payer: First Health Commercial |
$181.92
|
| Rate for Payer: Humana Commercial |
$162.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.52
|
| Rate for Payer: Ohio Health Group HMO |
$143.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.36
|
| Rate for Payer: PHCS Commercial |
$183.84
|
| Rate for Payer: United Healthcare All Payer |
$168.52
|
|
|
VERI-FLEX STENT 2.75*32
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERI-FLEX STENT 2.75*32
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERI-FLEX STENT 3*32
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERI-FLEX STENT 3*32
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERI-FLEX STENT 3.5*32
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERI-FLEX STENT 3.5*32
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERI-FLEX STENT 4*32
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERI-FLEX STENT 4*32
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERI-FLEX STENT 4.5*32
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERI-FLEX STENT 4.5*32
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERI-FLEX STENT 5*32
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERI-FLEX STENT 5*32
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
VERIFY NOW PRU TEST
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem Medicaid |
$24.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.91
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Humana KY Medicaid |
$24.91
|
| Rate for Payer: Humana Medicare Advantage |
$24.91
|
| Rate for Payer: Kentucky WC Medicaid |
$25.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.68
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
VERIFY NOW PRU TEST
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.78
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.68
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
VERMOX EQUIV 100MG CHEW TAB
|
Facility
|
IP
|
$848.80
|
|
|
Service Code
|
NDC 64896066930
|
| Hospital Charge Code |
25001662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.34 |
| Max. Negotiated Rate |
$814.85 |
| Rate for Payer: Aetna Commercial |
$653.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$662.06
|
| Rate for Payer: Cash Price |
$424.40
|
| Rate for Payer: Cigna Commercial |
$704.50
|
| Rate for Payer: First Health Commercial |
$806.36
|
| Rate for Payer: Humana Commercial |
$721.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$696.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$626.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$746.94
|
| Rate for Payer: Ohio Health Group HMO |
$636.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$169.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.13
|
| Rate for Payer: PHCS Commercial |
$814.85
|
| Rate for Payer: United Healthcare All Payer |
$746.94
|
|
|
VERMOX EQUIV 100MG CHEW TAB
|
Facility
|
OP
|
$848.80
|
|
|
Service Code
|
NDC 64896066930
|
| Hospital Charge Code |
25001662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.34 |
| Max. Negotiated Rate |
$814.85 |
| Rate for Payer: Aetna Commercial |
$653.58
|
| Rate for Payer: Anthem Medicaid |
$291.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$662.06
|
| Rate for Payer: Cash Price |
$424.40
|
| Rate for Payer: Cigna Commercial |
$704.50
|
| Rate for Payer: First Health Commercial |
$806.36
|
| Rate for Payer: Humana Commercial |
$721.48
|
| Rate for Payer: Humana KY Medicaid |
$291.90
|
| Rate for Payer: Kentucky WC Medicaid |
$294.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$696.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$626.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$297.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$746.94
|
| Rate for Payer: Ohio Health Group HMO |
$636.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$169.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.13
|
| Rate for Payer: PHCS Commercial |
$814.85
|
| Rate for Payer: United Healthcare All Payer |
$746.94
|
|
|
VERRATA PLUS 185CM ST TIP GW
|
Facility
|
OP
|
$4,387.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna Commercial |
$3,378.38
|
| Rate for Payer: Anthem Medicaid |
$1,508.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,422.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna Commercial |
$3,641.62
|
| Rate for Payer: First Health Commercial |
$4,168.12
|
| Rate for Payer: Humana Commercial |
$3,729.38
|
| Rate for Payer: Humana KY Medicaid |
$1,508.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,524.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,539.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,861.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.12
|
| Rate for Payer: PHCS Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare All Payer |
$3,861.00
|
|
|
VERRATA PLUS 185CM ST TIP GW
|
Facility
|
IP
|
$4,387.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna Commercial |
$3,378.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,422.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna Commercial |
$3,641.62
|
| Rate for Payer: First Health Commercial |
$4,168.12
|
| Rate for Payer: Humana Commercial |
$3,729.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,861.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.12
|
| Rate for Payer: PHCS Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare All Payer |
$3,861.00
|
|
|
VERSA-DIAL 30*19*39MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.91 |
| Max. Negotiated Rate |
$8,403.02 |
| Rate for Payer: Aetna Commercial |
$6,739.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
| Rate for Payer: Cash Price |
$4,376.58
|
| Rate for Payer: Cigna Commercial |
$7,265.11
|
| Rate for Payer: First Health Commercial |
$8,315.49
|
| Rate for Payer: Humana Commercial |
$7,440.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
| Rate for Payer: PHCS Commercial |
$8,403.02
|
| Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
|
VERSA-DIAL 30*19*39MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.91 |
| Max. Negotiated Rate |
$8,403.02 |
| Rate for Payer: Aetna Commercial |
$6,739.93
|
| Rate for Payer: Anthem Medicaid |
$3,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
| Rate for Payer: Cash Price |
$4,376.58
|
| Rate for Payer: Cigna Commercial |
$7,265.11
|
| Rate for Payer: First Health Commercial |
$8,315.49
|
| Rate for Payer: Humana Commercial |
$7,440.18
|
| Rate for Payer: Humana KY Medicaid |
$3,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
| Rate for Payer: PHCS Commercial |
$8,403.02
|
| Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
|
VERSA-DIAL 30*21*38MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.91 |
| Max. Negotiated Rate |
$8,403.02 |
| Rate for Payer: Aetna Commercial |
$6,739.93
|
| Rate for Payer: Anthem Medicaid |
$3,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
| Rate for Payer: Cash Price |
$4,376.58
|
| Rate for Payer: Cigna Commercial |
$7,265.11
|
| Rate for Payer: First Health Commercial |
$8,315.49
|
| Rate for Payer: Humana Commercial |
$7,440.18
|
| Rate for Payer: Humana KY Medicaid |
$3,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
| Rate for Payer: PHCS Commercial |
$8,403.02
|
| Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
|
VERSA-DIAL 30*21*38MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.91 |
| Max. Negotiated Rate |
$8,403.02 |
| Rate for Payer: Aetna Commercial |
$6,739.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
| Rate for Payer: Cash Price |
$4,376.58
|
| Rate for Payer: Cigna Commercial |
$7,265.11
|
| Rate for Payer: First Health Commercial |
$8,315.49
|
| Rate for Payer: Humana Commercial |
$7,440.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
| Rate for Payer: PHCS Commercial |
$8,403.02
|
| Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
|
VERSA-DIAL 42*18*46MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.91 |
| Max. Negotiated Rate |
$8,403.02 |
| Rate for Payer: Aetna Commercial |
$6,739.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
| Rate for Payer: Cash Price |
$4,376.58
|
| Rate for Payer: Cigna Commercial |
$7,265.11
|
| Rate for Payer: First Health Commercial |
$8,315.49
|
| Rate for Payer: Humana Commercial |
$7,440.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
| Rate for Payer: PHCS Commercial |
$8,403.02
|
| Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
|
VERSA-DIAL 42*18*46MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.91 |
| Max. Negotiated Rate |
$8,403.02 |
| Rate for Payer: Aetna Commercial |
$6,739.93
|
| Rate for Payer: Anthem Medicaid |
$3,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
| Rate for Payer: Cash Price |
$4,376.58
|
| Rate for Payer: Cigna Commercial |
$7,265.11
|
| Rate for Payer: First Health Commercial |
$8,315.49
|
| Rate for Payer: Humana Commercial |
$7,440.18
|
| Rate for Payer: Humana KY Medicaid |
$3,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
| Rate for Payer: PHCS Commercial |
$8,403.02
|
| Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
