|
BALLOON SPACEMAKER PLUS OVAL
|
Facility
|
OP
|
$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 Medicaid |
$1,867.23
|
| 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: Humana KY Medicaid |
$1,867.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,886.23
|
| 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: Molina Healthcare Medicaid |
$1,904.69
|
| 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
|
|
|
BALLOON SURG DISSECT OMS-PDBS2
|
Facility
|
OP
|
$2,126.16
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$2,041.11 |
| Rate for Payer: Aetna Commercial |
$1,637.14
|
| Rate for Payer: Anthem Medicaid |
$731.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,063.08
|
| Rate for Payer: Cigna Commercial |
$1,764.71
|
| Rate for Payer: First Health Commercial |
$2,019.85
|
| Rate for Payer: Humana Commercial |
$1,807.24
|
| Rate for Payer: Humana KY Medicaid |
$731.19
|
| Rate for Payer: Kentucky WC Medicaid |
$738.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.11
|
| Rate for Payer: PHCS Commercial |
$2,041.11
|
| Rate for Payer: United Healthcare All Payer |
$1,871.02
|
|
|
BALLOON SURG DISSECT OMS-PDBS2
|
Facility
|
IP
|
$2,126.16
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$2,041.11 |
| Rate for Payer: Aetna Commercial |
$1,637.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,063.08
|
| Rate for Payer: Cigna Commercial |
$1,764.71
|
| Rate for Payer: First Health Commercial |
$2,019.85
|
| Rate for Payer: Humana Commercial |
$1,807.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.11
|
| Rate for Payer: PHCS Commercial |
$2,041.11
|
| Rate for Payer: United Healthcare All Payer |
$1,871.02
|
|
|
BALLOON WEDGE CATH 5F 110C
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
BALLOON WEDGE CATH 5F 110C
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
BALO ANGIOP CTR DIALYSIS SEG
|
Facility
|
IP
|
$7,118.00
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
48100034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$925.34 |
| Max. Negotiated Rate |
$6,833.28 |
| Rate for Payer: Aetna Commercial |
$5,480.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,552.04
|
| Rate for Payer: Cash Price |
$3,559.00
|
| Rate for Payer: Cigna Commercial |
$5,907.94
|
| Rate for Payer: First Health Commercial |
$6,762.10
|
| Rate for Payer: Humana Commercial |
$6,050.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,836.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,253.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,263.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,338.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,423.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$925.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,206.58
|
| Rate for Payer: PHCS Commercial |
$6,833.28
|
| Rate for Payer: United Healthcare All Payer |
$6,263.84
|
|
|
BALO ANGIOP CTR DIALYSIS SEG
|
Facility
|
OP
|
$7,118.00
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
48100034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$925.34 |
| Max. Negotiated Rate |
$6,833.28 |
| Rate for Payer: Aetna Commercial |
$5,480.86
|
| Rate for Payer: Anthem Medicaid |
$2,447.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,552.04
|
| Rate for Payer: Cash Price |
$3,559.00
|
| Rate for Payer: Cigna Commercial |
$5,907.94
|
| Rate for Payer: First Health Commercial |
$6,762.10
|
| Rate for Payer: Humana Commercial |
$6,050.30
|
| Rate for Payer: Humana KY Medicaid |
$2,447.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,472.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,836.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,253.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,496.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,263.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,338.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,423.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$925.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,206.58
|
| Rate for Payer: PHCS Commercial |
$6,833.28
|
| Rate for Payer: United Healthcare All Payer |
$6,263.84
|
|
|
BALO ANGIOP CTR DIALYSIS SEG
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
76101520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.11 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.04
|
| Rate for Payer: Anthem Medicaid |
$102.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$208.79
|
| Rate for Payer: Humana Medicaid |
$102.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.15
|
| Rate for Payer: Molina Healthcare Passport |
$102.11
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$112.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.13
|
|
|
BALO ANGIOP CTR DIALYSIS SEG
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
76101520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem Medicaid |
$146.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Humana KY Medicaid |
$146.16
|
| Rate for Payer: Kentucky WC Medicaid |
$147.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
BALO ANGIOP CTR DIALYSIS SEG
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
76101520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
BALO ANGIOP CTR DIALYSIS SE(P
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
761P1520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.11 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.04
|
| Rate for Payer: Anthem Medicaid |
$102.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$208.79
|
| Rate for Payer: Humana Medicaid |
$102.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.15
|
| Rate for Payer: Molina Healthcare Passport |
$102.11
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$112.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.13
|
|
|
BALOON ATTAIN VENOGRMCATH 6215
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
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
|
|
|
BALOON ATTAIN VENOGRMCATH 6215
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
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
|
|
|
BALOON CREPUL 12-13.5-15MM*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
|
|
|
BALOON CREPUL 12-13.5-15MM*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
|
|
|
BALOON CREPUL 15-16.5-18MM*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
|
|
|
BALOON CREPUL 15-16.5-18MM*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
|
|
|
BALOON EXTRACTION 4.5FR*1900MM
|
Facility
|
IP
|
$1,731.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.10 |
| Max. Negotiated Rate |
$1,662.24 |
| Rate for Payer: Aetna Commercial |
$1,333.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,350.57
|
| Rate for Payer: Cash Price |
$865.75
|
| Rate for Payer: Cigna Commercial |
$1,437.14
|
| Rate for Payer: First Health Commercial |
$1,644.92
|
| Rate for Payer: Humana Commercial |
$1,471.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,419.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,277.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,523.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,298.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.76
|
| Rate for Payer: PHCS Commercial |
$1,662.24
|
| Rate for Payer: United Healthcare All Payer |
$1,523.72
|
|
|
BALOON EXTRACTION 4.5FR*1900MM
|
Facility
|
OP
|
$1,731.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.10 |
| Max. Negotiated Rate |
$1,662.24 |
| Rate for Payer: Aetna Commercial |
$1,333.26
|
| Rate for Payer: Anthem Medicaid |
$595.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,350.57
|
| Rate for Payer: Cash Price |
$865.75
|
| Rate for Payer: Cigna Commercial |
$1,437.14
|
| Rate for Payer: First Health Commercial |
$1,644.92
|
| Rate for Payer: Humana Commercial |
$1,471.78
|
| Rate for Payer: Humana KY Medicaid |
$595.46
|
| Rate for Payer: Kentucky WC Medicaid |
$601.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,419.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,277.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$607.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,523.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,298.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.76
|
| Rate for Payer: PHCS Commercial |
$1,662.24
|
| Rate for Payer: United Healthcare All Payer |
$1,523.72
|
|
|
BALOON PERIPHL CUTTNG 5*2*90
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BALOON PERIPHL CUTTNG 5*2*90
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BALOON PERIPHL CUTTNG 7*2*50
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BALOON PERIPHL CUTTNG 7*2*50
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BALOON PERIPHL CUTTNG 7*2*90
|
Facility
|
IP
|
$5,084.56
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$660.99 |
| Max. Negotiated Rate |
$4,881.18 |
| Rate for Payer: Aetna Commercial |
$3,915.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.96
|
| Rate for Payer: Cash Price |
$2,542.28
|
| Rate for Payer: Cigna Commercial |
$4,220.18
|
| Rate for Payer: First Health Commercial |
$4,830.33
|
| Rate for Payer: Humana Commercial |
$4,321.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,169.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,752.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,474.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.21
|
| Rate for Payer: PHCS Commercial |
$4,881.18
|
| Rate for Payer: United Healthcare All Payer |
$4,474.41
|
|
|
BALOON PERIPHL CUTTNG 7*2*90
|
Facility
|
OP
|
$5,084.56
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$660.99 |
| Max. Negotiated Rate |
$4,881.18 |
| Rate for Payer: Aetna Commercial |
$3,915.11
|
| Rate for Payer: Anthem Medicaid |
$1,748.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.96
|
| Rate for Payer: Cash Price |
$2,542.28
|
| Rate for Payer: Cigna Commercial |
$4,220.18
|
| Rate for Payer: First Health Commercial |
$4,830.33
|
| Rate for Payer: Humana Commercial |
$4,321.88
|
| Rate for Payer: Humana KY Medicaid |
$1,748.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,766.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,169.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,752.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,783.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,474.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.21
|
| Rate for Payer: PHCS Commercial |
$4,881.18
|
| Rate for Payer: United Healthcare All Payer |
$4,474.41
|
|
