|
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
|
|
|
ANGIOSCULPT OTW 4*100 137CM
|
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 OTW 4*100 137CM
|
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 OTW 4*20 137CM
|
Facility
|
IP
|
$5,281.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,584.38 |
| Max. Negotiated Rate |
$5,070.00 |
| Rate for Payer: Aetna Commercial |
$4,066.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,119.38
|
| Rate for Payer: Cash Price |
$2,640.62
|
| Rate for Payer: Cigna Commercial |
$4,383.44
|
| Rate for Payer: First Health Commercial |
$5,017.19
|
| Rate for Payer: Humana Commercial |
$4,489.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,330.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,897.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,647.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,594.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,644.06
|
| Rate for Payer: PHCS Commercial |
$5,070.00
|
| Rate for Payer: United Healthcare All Payer |
$4,647.50
|
|
|
ANGIOSCULPT OTW 4*20 137CM
|
Facility
|
OP
|
$5,281.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,584.38 |
| Max. Negotiated Rate |
$5,070.00 |
| Rate for Payer: Aetna Commercial |
$4,066.56
|
| Rate for Payer: Anthem Medicaid |
$1,816.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,119.38
|
| Rate for Payer: Cash Price |
$2,640.62
|
| Rate for Payer: Cigna Commercial |
$4,383.44
|
| Rate for Payer: First Health Commercial |
$5,017.19
|
| Rate for Payer: Humana Commercial |
$4,489.06
|
| Rate for Payer: Humana KY Medicaid |
$1,816.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,330.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,897.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,647.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,594.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,644.06
|
| Rate for Payer: PHCS Commercial |
$5,070.00
|
| Rate for Payer: United Healthcare All Payer |
$4,647.50
|
|
|
ANGIOSCULPT OTW 4*40 137CM
|
Facility
|
IP
|
$6,923.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,077.12 |
| Max. Negotiated Rate |
$6,646.80 |
| Rate for Payer: Aetna Commercial |
$5,331.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,400.52
|
| Rate for Payer: Cash Price |
$3,461.88
|
| Rate for Payer: Cigna Commercial |
$5,746.71
|
| Rate for Payer: First Health Commercial |
$6,577.56
|
| Rate for Payer: Humana Commercial |
$5,885.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,677.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,109.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,077.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,092.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,192.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,539.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,023.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,777.39
|
| Rate for Payer: PHCS Commercial |
$6,646.80
|
| Rate for Payer: United Healthcare All Payer |
$6,092.90
|
|
|
ANGIOSCULPT OTW 4*40 137CM
|
Facility
|
OP
|
$6,923.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,077.12 |
| Max. Negotiated Rate |
$6,646.80 |
| Rate for Payer: Aetna Commercial |
$5,331.29
|
| Rate for Payer: Anthem Medicaid |
$2,381.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,400.52
|
| Rate for Payer: Cash Price |
$3,461.88
|
| Rate for Payer: Cigna Commercial |
$5,746.71
|
| Rate for Payer: First Health Commercial |
$6,577.56
|
| Rate for Payer: Humana Commercial |
$5,885.19
|
| Rate for Payer: Humana KY Medicaid |
$2,381.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,405.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,677.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,109.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,077.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,428.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,092.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,192.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,539.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,023.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,777.39
|
| Rate for Payer: PHCS Commercial |
$6,646.80
|
| Rate for Payer: United Healthcare All Payer |
$6,092.90
|
|
|
ANGIOSCULPT OTW 5*100 137CM
|
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 OTW 5*100 137CM
|
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 OTW 5*20 137CM
|
Facility
|
OP
|
$5,281.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,584.38 |
| Max. Negotiated Rate |
$5,070.00 |
| Rate for Payer: Aetna Commercial |
$4,066.56
|
| Rate for Payer: Anthem Medicaid |
$1,816.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,119.38
|
| Rate for Payer: Cash Price |
$2,640.62
|
| Rate for Payer: Cigna Commercial |
$4,383.44
|
| Rate for Payer: First Health Commercial |
$5,017.19
|
| Rate for Payer: Humana Commercial |
$4,489.06
|
| Rate for Payer: Humana KY Medicaid |
$1,816.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,330.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,897.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,647.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,594.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,644.06
|
| Rate for Payer: PHCS Commercial |
$5,070.00
|
| Rate for Payer: United Healthcare All Payer |
$4,647.50
|
|
|
ANGIOSCULPT OTW 5*20 137CM
|
Facility
|
IP
|
$5,281.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,584.38 |
| Max. Negotiated Rate |
$5,070.00 |
| Rate for Payer: Aetna Commercial |
$4,066.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,119.38
|
| Rate for Payer: Cash Price |
$2,640.62
|
| Rate for Payer: Cigna Commercial |
$4,383.44
|
| Rate for Payer: First Health Commercial |
$5,017.19
|
| Rate for Payer: Humana Commercial |
$4,489.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,330.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,897.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,647.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,594.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,644.06
|
| Rate for Payer: PHCS Commercial |
$5,070.00
|
| Rate for Payer: United Healthcare All Payer |
$4,647.50
|
|
|
ANGIOSCULPT OTW 5*40 137CM
|
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 5*40 137CM
|
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 5*40 90CM
|
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 5*40 90CM
|
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 6*100 137CM
|
Facility
|
OP
|
$7,617.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,285.18 |
| Max. Negotiated Rate |
$7,312.56 |
| Rate for Payer: Aetna Commercial |
$5,865.28
|
| Rate for Payer: Anthem Medicaid |
$2,619.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,941.45
|
| Rate for Payer: Cash Price |
$3,808.62
|
| Rate for Payer: Cigna Commercial |
$6,322.32
|
| Rate for Payer: First Health Commercial |
$7,236.39
|
| Rate for Payer: Humana Commercial |
$6,474.66
|
| Rate for Payer: Humana KY Medicaid |
$2,619.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,621.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,712.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,093.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,627.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,255.90
|
| Rate for Payer: PHCS Commercial |
$7,312.56
|
| Rate for Payer: United Healthcare All Payer |
$6,703.18
|
|
|
ANGIOSCULPT OTW 6*100 137CM
|
Facility
|
IP
|
$7,617.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,285.18 |
| Max. Negotiated Rate |
$7,312.56 |
| Rate for Payer: Aetna Commercial |
$5,865.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,941.45
|
| Rate for Payer: Cash Price |
$3,808.62
|
| Rate for Payer: Cigna Commercial |
$6,322.32
|
| Rate for Payer: First Health Commercial |
$7,236.39
|
| Rate for Payer: Humana Commercial |
$6,474.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,621.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,712.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,093.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,627.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,255.90
|
| Rate for Payer: PHCS Commercial |
$7,312.56
|
| Rate for Payer: United Healthcare All Payer |
$6,703.18
|
|
|
ANGIOSCULPT OTW 6*20 137CM
|
Facility
|
IP
|
$5,618.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,685.62 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Aetna Commercial |
$4,326.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.62
|
| Rate for Payer: Cash Price |
$2,809.38
|
| Rate for Payer: Cigna Commercial |
$4,663.56
|
| Rate for Payer: First Health Commercial |
$5,337.81
|
| Rate for Payer: Humana Commercial |
$4,775.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,607.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,944.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,214.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,888.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,876.94
|
| Rate for Payer: PHCS Commercial |
$5,394.00
|
| Rate for Payer: United Healthcare All Payer |
$4,944.50
|
|
|
ANGIOSCULPT OTW 6*20 137CM
|
Facility
|
OP
|
$5,618.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,685.62 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Aetna Commercial |
$4,326.44
|
| Rate for Payer: Anthem Medicaid |
$1,932.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.62
|
| Rate for Payer: Cash Price |
$2,809.38
|
| Rate for Payer: Cigna Commercial |
$4,663.56
|
| Rate for Payer: First Health Commercial |
$5,337.81
|
| Rate for Payer: Humana Commercial |
$4,775.94
|
| Rate for Payer: Humana KY Medicaid |
$1,932.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,951.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,607.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,971.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,944.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,214.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,888.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,876.94
|
| Rate for Payer: PHCS Commercial |
$5,394.00
|
| Rate for Payer: United Healthcare All Payer |
$4,944.50
|
|
|
ANGIOSCULPT OTW 6*20 90CM
|
Facility
|
IP
|
$5,281.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,584.38 |
| Max. Negotiated Rate |
$5,070.00 |
| Rate for Payer: Aetna Commercial |
$4,066.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,119.38
|
| Rate for Payer: Cash Price |
$2,640.62
|
| Rate for Payer: Cigna Commercial |
$4,383.44
|
| Rate for Payer: First Health Commercial |
$5,017.19
|
| Rate for Payer: Humana Commercial |
$4,489.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,330.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,897.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,647.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,594.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,644.06
|
| Rate for Payer: PHCS Commercial |
$5,070.00
|
| Rate for Payer: United Healthcare All Payer |
$4,647.50
|
|
|
ANGIOSCULPT OTW 6*20 90CM
|
Facility
|
OP
|
$5,281.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,584.38 |
| Max. Negotiated Rate |
$5,070.00 |
| Rate for Payer: Aetna Commercial |
$4,066.56
|
| Rate for Payer: Anthem Medicaid |
$1,816.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,119.38
|
| Rate for Payer: Cash Price |
$2,640.62
|
| Rate for Payer: Cigna Commercial |
$4,383.44
|
| Rate for Payer: First Health Commercial |
$5,017.19
|
| Rate for Payer: Humana Commercial |
$4,489.06
|
| Rate for Payer: Humana KY Medicaid |
$1,816.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,330.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,897.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,647.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,594.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,644.06
|
| Rate for Payer: PHCS Commercial |
$5,070.00
|
| Rate for Payer: United Healthcare All Payer |
$4,647.50
|
|
|
ANGIOSCULPT OTW 6*40 137CM
|
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 6*40 137CM
|
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 6*40 90CM
|
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 6*40 90CM
|
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
|
|
