|
ANGIOSCULPT 2.5*100
|
Facility
|
IP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
|
ANGIOSCULPT 2.5*100
|
Facility
|
OP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem Medicaid |
$2,475.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Humana KY Medicaid |
$2,475.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,500.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
|
ANGIOSCULPT 3*100
|
Facility
|
OP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem Medicaid |
$2,475.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Humana KY Medicaid |
$2,475.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,500.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
|
ANGIOSCULPT 3*100
|
Facility
|
IP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
|
ANGIOSCULPT 3.5*100
|
Facility
|
OP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem Medicaid |
$2,475.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Humana KY Medicaid |
$2,475.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,500.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
|
ANGIOSCULPT 3.5*100
|
Facility
|
IP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
|
ANGIOSCULPT BALLOON 4*200
|
Facility
|
IP
|
$7,471.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,241.38 |
| Max. Negotiated Rate |
$7,172.40 |
| Rate for Payer: Aetna Commercial |
$5,752.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,827.57
|
| Rate for Payer: Cash Price |
$3,735.62
|
| Rate for Payer: Cigna Commercial |
$6,201.14
|
| Rate for Payer: First Health Commercial |
$7,097.69
|
| Rate for Payer: Humana Commercial |
$6,350.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,126.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,513.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,574.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,603.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,499.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,155.16
|
| Rate for Payer: PHCS Commercial |
$7,172.40
|
| Rate for Payer: United Healthcare All Payer |
$6,574.70
|
|
|
ANGIOSCULPT BALLOON 4*200
|
Facility
|
OP
|
$7,471.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,241.38 |
| Max. Negotiated Rate |
$7,172.40 |
| Rate for Payer: Aetna Commercial |
$5,752.86
|
| Rate for Payer: Anthem Medicaid |
$2,569.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,827.57
|
| Rate for Payer: Cash Price |
$3,735.62
|
| Rate for Payer: Cigna Commercial |
$6,201.14
|
| Rate for Payer: First Health Commercial |
$7,097.69
|
| Rate for Payer: Humana Commercial |
$6,350.56
|
| Rate for Payer: Humana KY Medicaid |
$2,569.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,595.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,126.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,513.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,620.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,574.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,603.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,499.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,155.16
|
| Rate for Payer: PHCS Commercial |
$7,172.40
|
| Rate for Payer: United Healthcare All Payer |
$6,574.70
|
|
|
ANGIOSCULPT BALLOON 5*200
|
Facility
|
OP
|
$7,471.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,241.38 |
| Max. Negotiated Rate |
$7,172.40 |
| Rate for Payer: Aetna Commercial |
$5,752.86
|
| Rate for Payer: Anthem Medicaid |
$2,569.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,827.57
|
| Rate for Payer: Cash Price |
$3,735.62
|
| Rate for Payer: Cigna Commercial |
$6,201.14
|
| Rate for Payer: First Health Commercial |
$7,097.69
|
| Rate for Payer: Humana Commercial |
$6,350.56
|
| Rate for Payer: Humana KY Medicaid |
$2,569.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,595.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,126.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,513.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,620.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,574.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,603.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,499.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,155.16
|
| Rate for Payer: PHCS Commercial |
$7,172.40
|
| Rate for Payer: United Healthcare All Payer |
$6,574.70
|
|
|
ANGIOSCULPT BALLOON 5*200
|
Facility
|
IP
|
$7,471.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,241.38 |
| Max. Negotiated Rate |
$7,172.40 |
| Rate for Payer: Aetna Commercial |
$5,752.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,827.57
|
| Rate for Payer: Cash Price |
$3,735.62
|
| Rate for Payer: Cigna Commercial |
$6,201.14
|
| Rate for Payer: First Health Commercial |
$7,097.69
|
| Rate for Payer: Humana Commercial |
$6,350.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,126.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,513.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,574.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,603.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,499.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,155.16
|
| Rate for Payer: PHCS Commercial |
$7,172.40
|
| Rate for Payer: United Healthcare All Payer |
$6,574.70
|
|
|
ANGIOSCULPT BALLOON 6*200
|
Facility
|
OP
|
$7,471.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,241.38 |
| Max. Negotiated Rate |
$7,172.40 |
| Rate for Payer: Aetna Commercial |
$5,752.86
|
| Rate for Payer: Anthem Medicaid |
$2,569.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,827.57
|
| Rate for Payer: Cash Price |
$3,735.62
|
| Rate for Payer: Cigna Commercial |
$6,201.14
|
| Rate for Payer: First Health Commercial |
$7,097.69
|
| Rate for Payer: Humana Commercial |
$6,350.56
|
| Rate for Payer: Humana KY Medicaid |
$2,569.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,595.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,126.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,513.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,620.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,574.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,603.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,499.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,155.16
|
| Rate for Payer: PHCS Commercial |
$7,172.40
|
| Rate for Payer: United Healthcare All Payer |
$6,574.70
|
|
|
ANGIOSCULPT BALLOON 6*200
|
Facility
|
IP
|
$7,471.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,241.38 |
| Max. Negotiated Rate |
$7,172.40 |
| Rate for Payer: Aetna Commercial |
$5,752.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,827.57
|
| Rate for Payer: Cash Price |
$3,735.62
|
| Rate for Payer: Cigna Commercial |
$6,201.14
|
| Rate for Payer: First Health Commercial |
$7,097.69
|
| Rate for Payer: Humana Commercial |
$6,350.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,126.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,513.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,574.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,603.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,499.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,155.16
|
| Rate for Payer: PHCS Commercial |
$7,172.40
|
| Rate for Payer: United Healthcare All Payer |
$6,574.70
|
|
|
ANGIOSCULPT OTW 2*40
|
Facility
|
OP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem Medicaid |
$1,945.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Humana KY Medicaid |
$1,945.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,964.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
|
ANGIOSCULPT OTW 2*40
|
Facility
|
IP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
|
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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIOSCULPT OTW 2.5*40
|
Facility
|
IP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
|
ANGIOSCULPT OTW 2.5*40
|
Facility
|
OP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem Medicaid |
$1,945.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Humana KY Medicaid |
$1,945.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,964.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
|
ANGIOSCULPT OTW 3*20 137CM
|
Facility
|
OP
|
$5,300.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$5,088.00 |
| Rate for Payer: Aetna Commercial |
$4,081.00
|
| Rate for Payer: Anthem Medicaid |
$1,822.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,650.00
|
| Rate for Payer: Cigna Commercial |
$4,399.00
|
| Rate for Payer: First Health Commercial |
$5,035.00
|
| Rate for Payer: Humana Commercial |
$4,505.00
|
| Rate for Payer: Humana KY Medicaid |
$1,822.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,841.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,346.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,911.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,664.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,611.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,657.00
|
| Rate for Payer: PHCS Commercial |
$5,088.00
|
| Rate for Payer: United Healthcare All Payer |
$4,664.00
|
|
|
ANGIOSCULPT OTW 3*20 137CM
|
Facility
|
IP
|
$5,300.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$5,088.00 |
| Rate for Payer: Aetna Commercial |
$4,081.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,650.00
|
| Rate for Payer: Cigna Commercial |
$4,399.00
|
| Rate for Payer: First Health Commercial |
$5,035.00
|
| Rate for Payer: Humana Commercial |
$4,505.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,346.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,911.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,664.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,611.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,657.00
|
| Rate for Payer: PHCS Commercial |
$5,088.00
|
| Rate for Payer: United Healthcare All Payer |
$4,664.00
|
|
|
ANGIOSCULPT OTW 3*40
|
Facility
|
OP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem Medicaid |
$1,945.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Humana KY Medicaid |
$1,945.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,964.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
|
ANGIOSCULPT OTW 3*40
|
Facility
|
IP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
|
ANGIOSCULPT OTW 3.5*20 137CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIOSCULPT OTW 3.5*20 137CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIOSCULPT OTW 3.5*40
|
Facility
|
OP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem Medicaid |
$1,945.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Humana KY Medicaid |
$1,945.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,964.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
