|
ADROIT JL 4 GUIDE CATH 6F
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ADROIT JL 4 GUIDE CATH 6F
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
ADROIT JR 4 GUIDE CATH 6F
|
Facility
|
IP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
ADROIT JR 4 GUIDE CATH 6F
|
Facility
|
OP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem Medicaid |
$379.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Humana KY Medicaid |
$379.87
|
| Rate for Payer: Kentucky WC Medicaid |
$383.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
ADROIT JR 4 SH GUIDE CATH 6F
|
Facility
|
OP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem Medicaid |
$379.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Humana KY Medicaid |
$379.87
|
| Rate for Payer: Kentucky WC Medicaid |
$383.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
ADROIT JR 4 SH GUIDE CATH 6F
|
Facility
|
IP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
ADROIT JR GUIDE CATH 5F 100CM
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
ADROIT JR GUIDE CATH 5F 100CM
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
ADROIT LCB GUIDE CATH 6F
|
Facility
|
IP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
ADROIT LCB GUIDE CATH 6F
|
Facility
|
OP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem Medicaid |
$379.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Humana KY Medicaid |
$379.87
|
| Rate for Payer: Kentucky WC Medicaid |
$383.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
ADROIT MPA-1 GUIDE CATH 6F
|
Facility
|
OP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem Medicaid |
$379.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Humana KY Medicaid |
$379.87
|
| Rate for Payer: Kentucky WC Medicaid |
$383.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
ADROIT MPA-1 GUIDE CATH 6F
|
Facility
|
IP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
ADROIT XB 3.5 GUIDE CATH 6F
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ADROIT XB 3.5 GUIDE CATH 6F
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ADROIT XBLAD 3.5 GUIDE CATH 6F
|
Facility
|
OP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem Medicaid |
$379.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Humana KY Medicaid |
$379.87
|
| Rate for Payer: Kentucky WC Medicaid |
$383.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
ADROIT XBLAD 3.5 GUIDE CATH 6F
|
Facility
|
IP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
ADVAIR 250-50MCG DISK (60)
|
Facility
|
IP
|
$10.23
|
|
|
Service Code
|
NDC 173069600
|
| Hospital Charge Code |
25002808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.98
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.49
|
| Rate for Payer: First Health Commercial |
$9.72
|
| Rate for Payer: Humana Commercial |
$8.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.00
|
| Rate for Payer: Ohio Health Group HMO |
$7.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.06
|
| Rate for Payer: PHCS Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Payer |
$9.00
|
|
|
ADVAIR 250-50MCG DISK (60)
|
Facility
|
OP
|
$10.23
|
|
|
Service Code
|
NDC 173069600
|
| Hospital Charge Code |
25002808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Anthem Medicaid |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.98
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.49
|
| Rate for Payer: First Health Commercial |
$9.72
|
| Rate for Payer: Humana Commercial |
$8.70
|
| Rate for Payer: Humana KY Medicaid |
$3.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.00
|
| Rate for Payer: Ohio Health Group HMO |
$7.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.06
|
| Rate for Payer: PHCS Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Payer |
$9.00
|
|
|
ADVAIR HFA (115/21 MCG) INH
|
Facility
|
IP
|
$7.70
|
|
|
Service Code
|
NDC 173071620
|
| Hospital Charge Code |
25000164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: Aetna Commercial |
$5.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.01
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cigna Commercial |
$6.39
|
| Rate for Payer: First Health Commercial |
$7.32
|
| Rate for Payer: Humana Commercial |
$6.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.78
|
| Rate for Payer: Ohio Health Group HMO |
$5.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.31
|
| Rate for Payer: PHCS Commercial |
$7.39
|
| Rate for Payer: United Healthcare All Payer |
$6.78
|
|
|
ADVAIR HFA (115/21 MCG) INH
|
Facility
|
OP
|
$7.70
|
|
|
Service Code
|
NDC 173071620
|
| Hospital Charge Code |
25000164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: Aetna Commercial |
$5.93
|
| Rate for Payer: Anthem Medicaid |
$2.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.01
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cigna Commercial |
$6.39
|
| Rate for Payer: First Health Commercial |
$7.32
|
| Rate for Payer: Humana Commercial |
$6.54
|
| Rate for Payer: Humana KY Medicaid |
$2.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.78
|
| Rate for Payer: Ohio Health Group HMO |
$5.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.31
|
| Rate for Payer: PHCS Commercial |
$7.39
|
| Rate for Payer: United Healthcare All Payer |
$6.78
|
|
|
ADVAIR HFA (230/21 MCG) INH
|
Facility
|
IP
|
$14.35
|
|
|
Service Code
|
NDC 173071722
|
| Hospital Charge Code |
25000165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$13.78 |
| Rate for Payer: Aetna Commercial |
$11.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.19
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cigna Commercial |
$11.91
|
| Rate for Payer: First Health Commercial |
$13.63
|
| Rate for Payer: Humana Commercial |
$12.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.63
|
| Rate for Payer: Ohio Health Group HMO |
$10.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.90
|
| Rate for Payer: PHCS Commercial |
$13.78
|
| Rate for Payer: United Healthcare All Payer |
$12.63
|
|
|
ADVAIR HFA (230/21 MCG) INH
|
Facility
|
OP
|
$14.35
|
|
|
Service Code
|
NDC 173071722
|
| Hospital Charge Code |
25000165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$13.78 |
| Rate for Payer: Aetna Commercial |
$11.05
|
| Rate for Payer: Anthem Medicaid |
$4.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.19
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cigna Commercial |
$11.91
|
| Rate for Payer: First Health Commercial |
$13.63
|
| Rate for Payer: Humana Commercial |
$12.20
|
| Rate for Payer: Humana KY Medicaid |
$4.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.63
|
| Rate for Payer: Ohio Health Group HMO |
$10.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.90
|
| Rate for Payer: PHCS Commercial |
$13.78
|
| Rate for Payer: United Healthcare All Payer |
$12.63
|
|
|
ADVANCE COCR TIB BASE NP SZ1 +
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADVANCE COCR TIB BASE NP SZ1 +
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADVANCE COCR TIB BASE NP SZ2 +
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
