|
ANGIOMAX KIT 1MG [250MG VIAL]
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
25001899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$181.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Humana KY Medicaid |
$181.58
|
| Rate for Payer: Kentucky WC Medicaid |
$183.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.68
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
ANGIOSCULPT 2*100
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
ANGIOSCULPT 2*100
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
|
|
ANGIOSCULPT 2.5*100
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
ANGIOSCULPT 2.5*100
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
ANGIOSCULPT 3*100
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
ANGIOSCULPT 3*100
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
ANGIOSCULPT 3.5*100
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
ANGIOSCULPT 3.5*100
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
ANGIOSCULPT BALLOON 4*200
|
Facility
|
IP
|
$7,271.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.26 |
| Max. Negotiated Rate |
$6,980.40 |
| Rate for Payer: Aetna Commercial |
$5,598.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,671.58
|
| Rate for Payer: Cash Price |
$3,635.62
|
| Rate for Payer: Cigna Commercial |
$6,035.14
|
| Rate for Payer: First Health Commercial |
$6,907.69
|
| Rate for Payer: Humana Commercial |
$6,180.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,962.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,366.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,181.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,398.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,453.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,254.09
|
| Rate for Payer: PHCS Commercial |
$6,980.40
|
| Rate for Payer: United Healthcare All Payer |
$6,398.70
|
|
|
ANGIOSCULPT BALLOON 4*200
|
Facility
|
OP
|
$7,271.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.26 |
| Max. Negotiated Rate |
$6,980.40 |
| Rate for Payer: Aetna Commercial |
$5,598.86
|
| Rate for Payer: Anthem Medicaid |
$2,500.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,671.58
|
| Rate for Payer: Cash Price |
$3,635.62
|
| Rate for Payer: Cigna Commercial |
$6,035.14
|
| Rate for Payer: First Health Commercial |
$6,907.69
|
| Rate for Payer: Humana Commercial |
$6,180.56
|
| Rate for Payer: Humana KY Medicaid |
$2,500.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,526.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,962.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,366.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,181.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,550.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,398.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,453.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,254.09
|
| Rate for Payer: PHCS Commercial |
$6,980.40
|
| Rate for Payer: United Healthcare All Payer |
$6,398.70
|
|
|
ANGIOSCULPT BALLOON 5*200
|
Facility
|
OP
|
$7,271.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.26 |
| Max. Negotiated Rate |
$6,980.40 |
| Rate for Payer: Aetna Commercial |
$5,598.86
|
| Rate for Payer: Anthem Medicaid |
$2,500.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,671.58
|
| Rate for Payer: Cash Price |
$3,635.62
|
| Rate for Payer: Cigna Commercial |
$6,035.14
|
| Rate for Payer: First Health Commercial |
$6,907.69
|
| Rate for Payer: Humana Commercial |
$6,180.56
|
| Rate for Payer: Humana KY Medicaid |
$2,500.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,526.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,962.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,366.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,181.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,550.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,398.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,453.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,254.09
|
| Rate for Payer: PHCS Commercial |
$6,980.40
|
| Rate for Payer: United Healthcare All Payer |
$6,398.70
|
|
|
ANGIOSCULPT BALLOON 5*200
|
Facility
|
IP
|
$7,271.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.26 |
| Max. Negotiated Rate |
$6,980.40 |
| Rate for Payer: Aetna Commercial |
$5,598.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,671.58
|
| Rate for Payer: Cash Price |
$3,635.62
|
| Rate for Payer: Cigna Commercial |
$6,035.14
|
| Rate for Payer: First Health Commercial |
$6,907.69
|
| Rate for Payer: Humana Commercial |
$6,180.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,962.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,366.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,181.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,398.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,453.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,254.09
|
| Rate for Payer: PHCS Commercial |
$6,980.40
|
| Rate for Payer: United Healthcare All Payer |
$6,398.70
|
|
|
ANGIOSCULPT BALLOON 6*200
|
Facility
|
OP
|
$7,271.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.26 |
| Max. Negotiated Rate |
$6,980.40 |
| Rate for Payer: Aetna Commercial |
$5,598.86
|
| Rate for Payer: Anthem Medicaid |
$2,500.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,671.58
|
| Rate for Payer: Cash Price |
$3,635.62
|
| Rate for Payer: Cigna Commercial |
$6,035.14
|
| Rate for Payer: First Health Commercial |
$6,907.69
|
| Rate for Payer: Humana Commercial |
$6,180.56
|
| Rate for Payer: Humana KY Medicaid |
$2,500.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,526.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,962.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,366.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,181.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,550.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,398.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,453.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,254.09
|
| Rate for Payer: PHCS Commercial |
$6,980.40
|
| Rate for Payer: United Healthcare All Payer |
$6,398.70
|
|
|
ANGIOSCULPT BALLOON 6*200
|
Facility
|
IP
|
$7,271.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.26 |
| Max. Negotiated Rate |
$6,980.40 |
| Rate for Payer: Aetna Commercial |
$5,598.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,671.58
|
| Rate for Payer: Cash Price |
$3,635.62
|
| Rate for Payer: Cigna Commercial |
$6,035.14
|
| Rate for Payer: First Health Commercial |
$6,907.69
|
| Rate for Payer: Humana Commercial |
$6,180.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,962.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,366.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,181.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,398.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,453.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,454.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,254.09
|
| Rate for Payer: PHCS Commercial |
$6,980.40
|
| Rate for Payer: United Healthcare All Payer |
$6,398.70
|
|
|
ANGIOSCULPT OTW 2*40
|
Facility
|
OP
|
$5,612.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.62 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna Commercial |
$4,321.62
|
| Rate for Payer: Anthem Medicaid |
$1,930.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.75
|
| Rate for Payer: Cash Price |
$2,806.25
|
| Rate for Payer: Cigna Commercial |
$4,658.38
|
| Rate for Payer: First Health Commercial |
$5,331.88
|
| Rate for Payer: Humana Commercial |
$4,770.62
|
| Rate for Payer: Humana KY Medicaid |
$1,930.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,949.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,968.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.88
|
| Rate for Payer: PHCS Commercial |
$5,388.00
|
| Rate for Payer: United Healthcare All Payer |
$4,939.00
|
|
|
ANGIOSCULPT OTW 2*40
|
Facility
|
IP
|
$5,612.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.62 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna Commercial |
$4,321.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.75
|
| Rate for Payer: Cash Price |
$2,806.25
|
| Rate for Payer: Cigna Commercial |
$4,658.38
|
| Rate for Payer: First Health Commercial |
$5,331.88
|
| Rate for Payer: Humana Commercial |
$4,770.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.88
|
| Rate for Payer: PHCS Commercial |
$5,388.00
|
| Rate for Payer: United Healthcare All Payer |
$4,939.00
|
|
|
ANGIOSCULPT OTW 2.5*20 137CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIOSCULPT OTW 2.5*20 137CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIOSCULPT OTW 2.5*40
|
Facility
|
OP
|
$5,612.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.62 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Anthem Medicaid |
$1,930.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.75
|
| Rate for Payer: Cash Price |
$2,806.25
|
| Rate for Payer: Cigna Commercial |
$4,658.38
|
| Rate for Payer: First Health Commercial |
$5,331.88
|
| Rate for Payer: Humana Commercial |
$4,770.62
|
| Rate for Payer: Humana KY Medicaid |
$1,930.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,949.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,968.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.88
|
| Rate for Payer: PHCS Commercial |
$5,388.00
|
| Rate for Payer: United Healthcare All Payer |
$4,939.00
|
| Rate for Payer: Aetna Commercial |
$4,321.62
|
|
|
ANGIOSCULPT OTW 2.5*40
|
Facility
|
IP
|
$5,612.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.62 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna Commercial |
$4,321.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.75
|
| Rate for Payer: Cash Price |
$2,806.25
|
| Rate for Payer: Cigna Commercial |
$4,658.38
|
| Rate for Payer: First Health Commercial |
$5,331.88
|
| Rate for Payer: Humana Commercial |
$4,770.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.88
|
| Rate for Payer: PHCS Commercial |
$5,388.00
|
| Rate for Payer: United Healthcare All Payer |
$4,939.00
|
|
|
ANGIOSCULPT OTW 3*20 137CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIOSCULPT OTW 3*20 137CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIOSCULPT OTW 3*40
|
Facility
|
OP
|
$5,612.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.62 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna Commercial |
$4,321.62
|
| Rate for Payer: Anthem Medicaid |
$1,930.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.75
|
| Rate for Payer: Cash Price |
$2,806.25
|
| Rate for Payer: Cigna Commercial |
$4,658.38
|
| Rate for Payer: First Health Commercial |
$5,331.88
|
| Rate for Payer: Humana Commercial |
$4,770.62
|
| Rate for Payer: Humana KY Medicaid |
$1,930.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,949.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,968.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.88
|
| Rate for Payer: PHCS Commercial |
$5,388.00
|
| Rate for Payer: United Healthcare All Payer |
$4,939.00
|
|
|
ANGIOSCULPT OTW 3*40
|
Facility
|
IP
|
$5,612.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.62 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna Commercial |
$4,321.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.75
|
| Rate for Payer: Cash Price |
$2,806.25
|
| Rate for Payer: Cigna Commercial |
$4,658.38
|
| Rate for Payer: First Health Commercial |
$5,331.88
|
| Rate for Payer: Humana Commercial |
$4,770.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.88
|
| Rate for Payer: PHCS Commercial |
$5,388.00
|
| Rate for Payer: United Healthcare All Payer |
$4,939.00
|
|
