|
BALLOON CATH MLD OC 10-37M 10F
|
Facility
|
IP
|
$4,209.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.17 |
| Max. Negotiated Rate |
$4,040.64 |
| Rate for Payer: Aetna Commercial |
$3,240.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,283.02
|
| Rate for Payer: Cash Price |
$2,104.50
|
| Rate for Payer: Cigna Commercial |
$3,493.47
|
| Rate for Payer: First Health Commercial |
$3,998.55
|
| Rate for Payer: Humana Commercial |
$3,577.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,451.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,106.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,262.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,703.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$841.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,304.79
|
| Rate for Payer: PHCS Commercial |
$4,040.64
|
| Rate for Payer: United Healthcare All Payer |
$3,703.92
|
|
|
BALLOON CATH MLD OC 10-37M 10F
|
Facility
|
OP
|
$4,209.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.17 |
| Max. Negotiated Rate |
$4,040.64 |
| Rate for Payer: Aetna Commercial |
$3,240.93
|
| Rate for Payer: Anthem Medicaid |
$1,447.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,283.02
|
| Rate for Payer: Cash Price |
$2,104.50
|
| Rate for Payer: Cigna Commercial |
$3,493.47
|
| Rate for Payer: First Health Commercial |
$3,998.55
|
| Rate for Payer: Humana Commercial |
$3,577.65
|
| Rate for Payer: Humana KY Medicaid |
$1,447.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,462.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,451.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,106.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,262.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,476.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,703.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$841.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,304.79
|
| Rate for Payer: PHCS Commercial |
$4,040.64
|
| Rate for Payer: United Healthcare All Payer |
$3,703.92
|
|
|
BALLOON CRE PUL 10-11-12MM*3.0
|
Facility
|
IP
|
$3,390.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.70 |
| Max. Negotiated Rate |
$3,254.40 |
| Rate for Payer: Aetna Commercial |
$2,610.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,644.20
|
| Rate for Payer: Cash Price |
$1,695.00
|
| Rate for Payer: Cigna Commercial |
$2,813.70
|
| Rate for Payer: First Health Commercial |
$3,220.50
|
| Rate for Payer: Humana Commercial |
$2,881.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,983.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,542.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.90
|
| Rate for Payer: PHCS Commercial |
$3,254.40
|
| Rate for Payer: United Healthcare All Payer |
$2,983.20
|
|
|
BALLOON CRE PUL 10-11-12MM*3.0
|
Facility
|
OP
|
$3,390.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.70 |
| Max. Negotiated Rate |
$3,254.40 |
| Rate for Payer: Aetna Commercial |
$2,610.30
|
| Rate for Payer: Anthem Medicaid |
$1,165.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,644.20
|
| Rate for Payer: Cash Price |
$1,695.00
|
| Rate for Payer: Cigna Commercial |
$2,813.70
|
| Rate for Payer: First Health Commercial |
$3,220.50
|
| Rate for Payer: Humana Commercial |
$2,881.50
|
| Rate for Payer: Humana KY Medicaid |
$1,165.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,177.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,189.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,983.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,542.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.90
|
| Rate for Payer: PHCS Commercial |
$3,254.40
|
| Rate for Payer: United Healthcare All Payer |
$2,983.20
|
|
|
BALLOON CRE PUL 18-19-20MM*5.5
|
Facility
|
OP
|
$3,390.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.70 |
| Max. Negotiated Rate |
$3,254.40 |
| Rate for Payer: Aetna Commercial |
$2,610.30
|
| Rate for Payer: Anthem Medicaid |
$1,165.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,644.20
|
| Rate for Payer: Cash Price |
$1,695.00
|
| Rate for Payer: Cigna Commercial |
$2,813.70
|
| Rate for Payer: First Health Commercial |
$3,220.50
|
| Rate for Payer: Humana Commercial |
$2,881.50
|
| Rate for Payer: Humana KY Medicaid |
$1,165.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,177.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,189.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,983.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,542.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.90
|
| Rate for Payer: PHCS Commercial |
$3,254.40
|
| Rate for Payer: United Healthcare All Payer |
$2,983.20
|
|
|
BALLOON CRE PUL 18-19-20MM*5.5
|
Facility
|
IP
|
$3,390.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.70 |
| Max. Negotiated Rate |
$3,254.40 |
| Rate for Payer: Aetna Commercial |
$2,610.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,644.20
|
| Rate for Payer: Cash Price |
$1,695.00
|
| Rate for Payer: Cigna Commercial |
$2,813.70
|
| Rate for Payer: First Health Commercial |
$3,220.50
|
| Rate for Payer: Humana Commercial |
$2,881.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,983.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,542.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.90
|
| Rate for Payer: PHCS Commercial |
$3,254.40
|
| Rate for Payer: United Healthcare All Payer |
$2,983.20
|
|
|
BALLOON CRE PULM 12-13.5-15 3.
|
Facility
|
OP
|
$3,302.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.32 |
| Max. Negotiated Rate |
$3,170.40 |
| Rate for Payer: Aetna Commercial |
$2,542.92
|
| Rate for Payer: Anthem Medicaid |
$1,135.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.95
|
| Rate for Payer: Cash Price |
$1,651.25
|
| Rate for Payer: Cigna Commercial |
$2,741.08
|
| Rate for Payer: First Health Commercial |
$3,137.38
|
| Rate for Payer: Humana Commercial |
$2,807.12
|
| Rate for Payer: Humana KY Medicaid |
$1,135.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,147.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,708.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,437.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,158.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,906.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,476.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.78
|
| Rate for Payer: PHCS Commercial |
$3,170.40
|
| Rate for Payer: United Healthcare All Payer |
$2,906.20
|
|
|
BALLOON CRE PULM 12-13.5-15 3.
|
Facility
|
IP
|
$3,302.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.32 |
| Max. Negotiated Rate |
$3,170.40 |
| Rate for Payer: Aetna Commercial |
$2,542.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.95
|
| Rate for Payer: Cash Price |
$1,651.25
|
| Rate for Payer: Cigna Commercial |
$2,741.08
|
| Rate for Payer: First Health Commercial |
$3,137.38
|
| Rate for Payer: Humana Commercial |
$2,807.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,708.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,437.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,906.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,476.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.78
|
| Rate for Payer: PHCS Commercial |
$3,170.40
|
| Rate for Payer: United Healthcare All Payer |
$2,906.20
|
|
|
BALLOON DILATOR 10-11-12 5847
|
Facility
|
IP
|
$2,111.74
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.53 |
| Max. Negotiated Rate |
$2,027.27 |
| Rate for Payer: Aetna Commercial |
$1,626.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.16
|
| Rate for Payer: Cash Price |
$1,055.87
|
| Rate for Payer: Cigna Commercial |
$1,752.74
|
| Rate for Payer: First Health Commercial |
$2,006.15
|
| Rate for Payer: Humana Commercial |
$1,794.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.64
|
| Rate for Payer: PHCS Commercial |
$2,027.27
|
| Rate for Payer: United Healthcare All Payer |
$1,858.33
|
|
|
BALLOON DILATOR 10-11-12 5847
|
Facility
|
OP
|
$2,111.74
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.53 |
| Max. Negotiated Rate |
$2,027.27 |
| Rate for Payer: Aetna Commercial |
$1,626.04
|
| Rate for Payer: Anthem Medicaid |
$726.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.16
|
| Rate for Payer: Cash Price |
$1,055.87
|
| Rate for Payer: Cigna Commercial |
$1,752.74
|
| Rate for Payer: First Health Commercial |
$2,006.15
|
| Rate for Payer: Humana Commercial |
$1,794.98
|
| Rate for Payer: Humana KY Medicaid |
$726.23
|
| Rate for Payer: Kentucky WC Medicaid |
$733.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.64
|
| Rate for Payer: PHCS Commercial |
$2,027.27
|
| Rate for Payer: United Healthcare All Payer |
$1,858.33
|
|
|
BALLOON DILATOR 12-13.5-15 584
|
Facility
|
OP
|
$2,111.74
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.53 |
| Max. Negotiated Rate |
$2,027.27 |
| Rate for Payer: Aetna Commercial |
$1,626.04
|
| Rate for Payer: Anthem Medicaid |
$726.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.16
|
| Rate for Payer: Cash Price |
$1,055.87
|
| Rate for Payer: Cigna Commercial |
$1,752.74
|
| Rate for Payer: First Health Commercial |
$2,006.15
|
| Rate for Payer: Humana Commercial |
$1,794.98
|
| Rate for Payer: Humana KY Medicaid |
$726.23
|
| Rate for Payer: Kentucky WC Medicaid |
$733.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.64
|
| Rate for Payer: PHCS Commercial |
$2,027.27
|
| Rate for Payer: United Healthcare All Payer |
$1,858.33
|
|
|
BALLOON DILATOR 12-13.5-15 584
|
Facility
|
IP
|
$2,111.74
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.53 |
| Max. Negotiated Rate |
$2,027.27 |
| Rate for Payer: Aetna Commercial |
$1,626.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.16
|
| Rate for Payer: Cash Price |
$1,055.87
|
| Rate for Payer: Cigna Commercial |
$1,752.74
|
| Rate for Payer: First Health Commercial |
$2,006.15
|
| Rate for Payer: Humana Commercial |
$1,794.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.64
|
| Rate for Payer: PHCS Commercial |
$2,027.27
|
| Rate for Payer: United Healthcare All Payer |
$1,858.33
|
|
|
BALLOON DILATOR 15-16.5-18 584
|
Facility
|
OP
|
$2,111.74
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.53 |
| Max. Negotiated Rate |
$2,027.27 |
| Rate for Payer: Aetna Commercial |
$1,626.04
|
| Rate for Payer: Anthem Medicaid |
$726.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.16
|
| Rate for Payer: Cash Price |
$1,055.87
|
| Rate for Payer: Cigna Commercial |
$1,752.74
|
| Rate for Payer: First Health Commercial |
$2,006.15
|
| Rate for Payer: Humana Commercial |
$1,794.98
|
| Rate for Payer: Humana KY Medicaid |
$726.23
|
| Rate for Payer: Kentucky WC Medicaid |
$733.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.64
|
| Rate for Payer: PHCS Commercial |
$2,027.27
|
| Rate for Payer: United Healthcare All Payer |
$1,858.33
|
|
|
BALLOON DILATOR 15-16.5-18 584
|
Facility
|
IP
|
$2,111.74
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.53 |
| Max. Negotiated Rate |
$2,027.27 |
| Rate for Payer: Aetna Commercial |
$1,626.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.16
|
| Rate for Payer: Cash Price |
$1,055.87
|
| Rate for Payer: Cigna Commercial |
$1,752.74
|
| Rate for Payer: First Health Commercial |
$2,006.15
|
| Rate for Payer: Humana Commercial |
$1,794.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.64
|
| Rate for Payer: PHCS Commercial |
$2,027.27
|
| Rate for Payer: United Healthcare All Payer |
$1,858.33
|
|
|
BALLOON DILATOR 6-7-8 5845
|
Facility
|
IP
|
$2,111.74
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.53 |
| Max. Negotiated Rate |
$2,027.27 |
| Rate for Payer: Aetna Commercial |
$1,626.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.16
|
| Rate for Payer: Cash Price |
$1,055.87
|
| Rate for Payer: Cigna Commercial |
$1,752.74
|
| Rate for Payer: First Health Commercial |
$2,006.15
|
| Rate for Payer: Humana Commercial |
$1,794.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.64
|
| Rate for Payer: PHCS Commercial |
$2,027.27
|
| Rate for Payer: United Healthcare All Payer |
$1,858.33
|
|
|
BALLOON DILATOR 6-7-8 5845
|
Facility
|
OP
|
$2,111.74
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.53 |
| Max. Negotiated Rate |
$2,027.27 |
| Rate for Payer: Aetna Commercial |
$1,626.04
|
| Rate for Payer: Anthem Medicaid |
$726.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.16
|
| Rate for Payer: Cash Price |
$1,055.87
|
| Rate for Payer: Cigna Commercial |
$1,752.74
|
| Rate for Payer: First Health Commercial |
$2,006.15
|
| Rate for Payer: Humana Commercial |
$1,794.98
|
| Rate for Payer: Humana KY Medicaid |
$726.23
|
| Rate for Payer: Kentucky WC Medicaid |
$733.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.64
|
| Rate for Payer: PHCS Commercial |
$2,027.27
|
| Rate for Payer: United Healthcare All Payer |
$1,858.33
|
|
|
BALLOON DILATOR 8-9-10 5846
|
Facility
|
IP
|
$2,129.62
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$2,044.44 |
| Rate for Payer: Aetna Commercial |
$1,639.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,661.10
|
| Rate for Payer: Cash Price |
$1,064.81
|
| Rate for Payer: Cigna Commercial |
$1,767.58
|
| Rate for Payer: First Health Commercial |
$2,023.14
|
| Rate for Payer: Humana Commercial |
$1,810.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,746.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,571.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,874.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,597.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.18
|
| Rate for Payer: PHCS Commercial |
$2,044.44
|
| Rate for Payer: United Healthcare All Payer |
$1,874.07
|
|
|
BALLOON DILATOR 8-9-10 5846
|
Facility
|
OP
|
$2,129.62
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$2,044.44 |
| Rate for Payer: Aetna Commercial |
$1,639.81
|
| Rate for Payer: Anthem Medicaid |
$732.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,661.10
|
| Rate for Payer: Cash Price |
$1,064.81
|
| Rate for Payer: Cigna Commercial |
$1,767.58
|
| Rate for Payer: First Health Commercial |
$2,023.14
|
| Rate for Payer: Humana Commercial |
$1,810.18
|
| Rate for Payer: Humana KY Medicaid |
$732.38
|
| Rate for Payer: Kentucky WC Medicaid |
$739.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,746.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,571.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$747.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,874.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,597.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.18
|
| Rate for Payer: PHCS Commercial |
$2,044.44
|
| Rate for Payer: United Healthcare All Payer |
$1,874.07
|
|
|
BALLOON KYPHOPLASTY BUNDLE
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BALLOON KYPHOPLASTY BUNDLE
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BALLOON RETRIEVAL 11.5M RAP EX
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Anthem Medicaid |
$632.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Humana KY Medicaid |
$632.78
|
| Rate for Payer: Kentucky WC Medicaid |
$639.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
| Rate for Payer: Aetna Commercial |
$1,416.80
|
|
|
BALLOON RETRIEVAL 11.5M RAP EX
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
BALLOON RETRIEVAL 15MM RAP EX
|
Facility
|
IP
|
$1,871.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.30 |
| Max. Negotiated Rate |
$1,796.64 |
| Rate for Payer: Aetna Commercial |
$1,441.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,459.77
|
| Rate for Payer: Cash Price |
$935.75
|
| Rate for Payer: Cigna Commercial |
$1,553.34
|
| Rate for Payer: First Health Commercial |
$1,777.92
|
| Rate for Payer: Humana Commercial |
$1,590.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,534.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,646.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,403.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.16
|
| Rate for Payer: PHCS Commercial |
$1,796.64
|
| Rate for Payer: United Healthcare All Payer |
$1,646.92
|
|
|
BALLOON RETRIEVAL 15MM RAP EX
|
Facility
|
OP
|
$1,871.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.30 |
| Max. Negotiated Rate |
$1,796.64 |
| Rate for Payer: Aetna Commercial |
$1,441.06
|
| Rate for Payer: Anthem Medicaid |
$643.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,459.77
|
| Rate for Payer: Cash Price |
$935.75
|
| Rate for Payer: Cigna Commercial |
$1,553.34
|
| Rate for Payer: First Health Commercial |
$1,777.92
|
| Rate for Payer: Humana Commercial |
$1,590.78
|
| Rate for Payer: Humana KY Medicaid |
$643.61
|
| Rate for Payer: Kentucky WC Medicaid |
$650.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,534.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,646.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,403.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.16
|
| Rate for Payer: PHCS Commercial |
$1,796.64
|
| Rate for Payer: United Healthcare All Payer |
$1,646.92
|
|
|
BALLOON SPACEMAKER PLUS OVAL
|
Facility
|
IP
|
$5,429.56
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.84 |
| Max. Negotiated Rate |
$5,212.38 |
| Rate for Payer: Aetna Commercial |
$4,180.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,235.06
|
| Rate for Payer: Cash Price |
$2,714.78
|
| Rate for Payer: Cigna Commercial |
$4,506.53
|
| Rate for Payer: First Health Commercial |
$5,158.08
|
| Rate for Payer: Humana Commercial |
$4,615.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,452.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,007.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,628.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,778.01
|
| Rate for Payer: Ohio Health Group HMO |
$4,072.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,085.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$705.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,683.16
|
| Rate for Payer: PHCS Commercial |
$5,212.38
|
| Rate for Payer: United Healthcare All Payer |
$4,778.01
|
|
