|
SABER BALLOON 3*25*150
|
Facility
|
IP
|
$2,218.21
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.37 |
| Max. Negotiated Rate |
$2,129.48 |
| Rate for Payer: Aetna Commercial |
$1,708.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,730.20
|
| Rate for Payer: Cash Price |
$1,109.11
|
| Rate for Payer: Cigna Commercial |
$1,841.11
|
| Rate for Payer: First Health Commercial |
$2,107.30
|
| Rate for Payer: Humana Commercial |
$1,885.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,818.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,637.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$665.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,952.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,663.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$687.65
|
| Rate for Payer: PHCS Commercial |
$2,129.48
|
| Rate for Payer: United Healthcare All Payer |
$1,952.02
|
|
|
SABER BALLOON 3*25*90
|
Facility
|
OP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem Medicaid |
$735.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Humana KY Medicaid |
$735.09
|
| Rate for Payer: Kentucky WC Medicaid |
$742.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
SABER BALLOON 3*25*90
|
Facility
|
IP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
SABER BALLOON 4*10*90
|
Facility
|
IP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
SABER BALLOON 4*10*90
|
Facility
|
OP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem Medicaid |
$735.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Humana KY Medicaid |
$735.09
|
| Rate for Payer: Kentucky WC Medicaid |
$742.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
SABER BALLOON 4*25*150
|
Facility
|
IP
|
$2,218.21
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.37 |
| Max. Negotiated Rate |
$2,129.48 |
| Rate for Payer: Aetna Commercial |
$1,708.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,730.20
|
| Rate for Payer: Cash Price |
$1,109.11
|
| Rate for Payer: Cigna Commercial |
$1,841.11
|
| Rate for Payer: First Health Commercial |
$2,107.30
|
| Rate for Payer: Humana Commercial |
$1,885.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,818.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,637.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$665.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,952.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,663.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$687.65
|
| Rate for Payer: PHCS Commercial |
$2,129.48
|
| Rate for Payer: United Healthcare All Payer |
$1,952.02
|
|
|
SABER BALLOON 4*25*150
|
Facility
|
OP
|
$2,218.21
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.37 |
| Max. Negotiated Rate |
$2,129.48 |
| Rate for Payer: Aetna Commercial |
$1,708.02
|
| Rate for Payer: Anthem Medicaid |
$762.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,730.20
|
| Rate for Payer: Cash Price |
$1,109.11
|
| Rate for Payer: Cigna Commercial |
$1,841.11
|
| Rate for Payer: First Health Commercial |
$2,107.30
|
| Rate for Payer: Humana Commercial |
$1,885.48
|
| Rate for Payer: Humana KY Medicaid |
$762.84
|
| Rate for Payer: Kentucky WC Medicaid |
$770.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,818.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,637.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$665.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$778.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,952.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,663.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$687.65
|
| Rate for Payer: PHCS Commercial |
$2,129.48
|
| Rate for Payer: United Healthcare All Payer |
$1,952.02
|
|
|
SABER BALLOON 4*30*150
|
Facility
|
OP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem Medicaid |
$748.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Humana KY Medicaid |
$748.63
|
| Rate for Payer: Kentucky WC Medicaid |
$756.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
|
SABER BALLOON 4*30*150
|
Facility
|
IP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
|
SABER BALLOON 6*20*150
|
Facility
|
OP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem Medicaid |
$748.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Humana KY Medicaid |
$748.63
|
| Rate for Payer: Kentucky WC Medicaid |
$756.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
|
SABER BALLOON 6*20*150
|
Facility
|
IP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
|
SABER BALLOON 6*25*150
|
Facility
|
IP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
SABER BALLOON 6*25*150
|
Facility
|
OP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem Medicaid |
$735.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Humana KY Medicaid |
$735.09
|
| Rate for Payer: Kentucky WC Medicaid |
$742.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
SABER BALLOON 6*30*150
|
Facility
|
IP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
|
SABER BALLOON 6*30*150
|
Facility
|
OP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem Medicaid |
$748.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Humana KY Medicaid |
$748.63
|
| Rate for Payer: Kentucky WC Medicaid |
$756.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
|
SACROSPINOPEXY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57282
|
| Hospital Charge Code |
76102186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.32 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$772.48
|
| Rate for Payer: Anthem Medicaid |
$516.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$739.90
|
| Rate for Payer: Healthspan PPO |
$747.95
|
| Rate for Payer: Humana Medicaid |
$516.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$650.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.65
|
| Rate for Payer: Molina Healthcare Passport |
$516.32
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.48
|
|
|
SACROSPINOPEXY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57282
|
| Hospital Charge Code |
76102186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
SACROSPINOPEXY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57282
|
| Hospital Charge Code |
76102186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$9,148.36 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,534.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,148.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,821.63
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$6,534.54
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,841.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
SACROSPINOPEXY(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57282
|
| Hospital Charge Code |
761P2186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.32 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$772.48
|
| Rate for Payer: Anthem Medicaid |
$516.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$739.90
|
| Rate for Payer: Healthspan PPO |
$747.95
|
| Rate for Payer: Humana Medicaid |
$516.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$650.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.65
|
| Rate for Payer: Molina Healthcare Passport |
$516.32
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.48
|
|
|
SAFESHEATH 10.5FR CLS-1010.5
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
SAFESHEATH 10.5FR CLS-1010.5
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
SAFESHEATH 10.5 FR HLS-10105M
|
Facility
|
OP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem Medicaid |
$388.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Humana KY Medicaid |
$388.44
|
| Rate for Payer: Kentucky WC Medicaid |
$392.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
SAFESHEATH 10.5 FR HLS-10105M
|
Facility
|
IP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
SAFESHEATH 10.5FR W/SIDEPORT
|
Facility
|
IP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
SAFESHEATH 10.5FR W/SIDEPORT
|
Facility
|
OP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem Medicaid |
$520.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Humana KY Medicaid |
$520.15
|
| Rate for Payer: Kentucky WC Medicaid |
$525.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
