|
SABER BALLOON 10*6*90
|
Facility
|
OP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem Medicaid |
$656.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Humana KY Medicaid |
$656.16
|
| Rate for Payer: Kentucky WC Medicaid |
$662.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$669.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
SABER BALLOON 10*6*90
|
Facility
|
IP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
SABER BALLOON 10*8*90
|
Facility
|
OP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem Medicaid |
$656.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Humana KY Medicaid |
$656.16
|
| Rate for Payer: Kentucky WC Medicaid |
$662.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$669.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
SABER BALLOON 10*8*90
|
Facility
|
IP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
SABER BALLOON 2*25*150
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
SABER BALLOON 2*25*150
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
SABER BALLOON 2*25*90
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
SABER BALLOON 2*25*90
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
SABER BALLOON 2*30*150
|
Facility
|
OP
|
$2,197.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.33 |
| Max. Negotiated Rate |
$2,109.84 |
| Rate for Payer: Aetna Commercial |
$1,692.27
|
| Rate for Payer: Anthem Medicaid |
$755.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,714.24
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,824.13
|
| Rate for Payer: First Health Commercial |
$2,087.86
|
| Rate for Payer: Humana Commercial |
$1,868.09
|
| Rate for Payer: Humana KY Medicaid |
$755.81
|
| Rate for Payer: Kentucky WC Medicaid |
$763.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,802.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$770.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,648.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,912.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.45
|
| Rate for Payer: PHCS Commercial |
$2,109.84
|
| Rate for Payer: United Healthcare All Payer |
$1,934.02
|
|
|
SABER BALLOON 2*30*150
|
Facility
|
IP
|
$2,197.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.33 |
| Max. Negotiated Rate |
$2,109.84 |
| Rate for Payer: Aetna Commercial |
$1,692.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,714.24
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,824.13
|
| Rate for Payer: First Health Commercial |
$2,087.86
|
| Rate for Payer: Humana Commercial |
$1,868.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,802.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,648.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,912.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.45
|
| Rate for Payer: PHCS Commercial |
$2,109.84
|
| Rate for Payer: United Healthcare All Payer |
$1,934.02
|
|
|
SABER BALLOON 3*20*150
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
SABER BALLOON 3*20*150
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
SABER BALLOON 3*25*150
|
Facility
|
IP
|
$2,242.63
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.79 |
| Max. Negotiated Rate |
$2,152.92 |
| Rate for Payer: Aetna Commercial |
$1,726.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,749.25
|
| Rate for Payer: Cash Price |
$1,121.31
|
| Rate for Payer: Cigna Commercial |
$1,861.38
|
| Rate for Payer: First Health Commercial |
$2,130.50
|
| Rate for Payer: Humana Commercial |
$1,906.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,655.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,973.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,951.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,547.41
|
| Rate for Payer: PHCS Commercial |
$2,152.92
|
| Rate for Payer: United Healthcare All Payer |
$1,973.51
|
|
|
SABER BALLOON 3*25*150
|
Facility
|
OP
|
$2,242.63
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.79 |
| Max. Negotiated Rate |
$2,152.92 |
| Rate for Payer: Aetna Commercial |
$1,726.83
|
| Rate for Payer: Anthem Medicaid |
$771.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,749.25
|
| Rate for Payer: Cash Price |
$1,121.31
|
| Rate for Payer: Cigna Commercial |
$1,861.38
|
| Rate for Payer: First Health Commercial |
$2,130.50
|
| Rate for Payer: Humana Commercial |
$1,906.24
|
| Rate for Payer: Humana KY Medicaid |
$771.24
|
| Rate for Payer: Kentucky WC Medicaid |
$779.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,655.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$786.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,973.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,951.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,547.41
|
| Rate for Payer: PHCS Commercial |
$2,152.92
|
| Rate for Payer: United Healthcare All Payer |
$1,973.51
|
|
|
SABER BALLOON 3*25*90
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
SABER BALLOON 3*25*90
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
SABER BALLOON 4*10*90
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
SABER BALLOON 4*10*90
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
SABER BALLOON 4*25*150
|
Facility
|
OP
|
$2,242.63
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.79 |
| Max. Negotiated Rate |
$2,152.92 |
| Rate for Payer: Aetna Commercial |
$1,726.83
|
| Rate for Payer: Anthem Medicaid |
$771.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,749.25
|
| Rate for Payer: Cash Price |
$1,121.31
|
| Rate for Payer: Cigna Commercial |
$1,861.38
|
| Rate for Payer: First Health Commercial |
$2,130.50
|
| Rate for Payer: Humana Commercial |
$1,906.24
|
| Rate for Payer: Humana KY Medicaid |
$771.24
|
| Rate for Payer: Kentucky WC Medicaid |
$779.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,655.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$786.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,973.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,951.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,547.41
|
| Rate for Payer: PHCS Commercial |
$2,152.92
|
| Rate for Payer: United Healthcare All Payer |
$1,973.51
|
|
|
SABER BALLOON 4*25*150
|
Facility
|
IP
|
$2,242.63
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.79 |
| Max. Negotiated Rate |
$2,152.92 |
| Rate for Payer: Aetna Commercial |
$1,726.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,749.25
|
| Rate for Payer: Cash Price |
$1,121.31
|
| Rate for Payer: Cigna Commercial |
$1,861.38
|
| Rate for Payer: First Health Commercial |
$2,130.50
|
| Rate for Payer: Humana Commercial |
$1,906.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,655.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,973.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,951.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,547.41
|
| Rate for Payer: PHCS Commercial |
$2,152.92
|
| Rate for Payer: United Healthcare All Payer |
$1,973.51
|
|
|
SABER BALLOON 4*30*150
|
Facility
|
IP
|
$2,197.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.33 |
| Max. Negotiated Rate |
$2,109.84 |
| Rate for Payer: Aetna Commercial |
$1,692.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,714.24
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,824.13
|
| Rate for Payer: First Health Commercial |
$2,087.86
|
| Rate for Payer: Humana Commercial |
$1,868.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,802.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,648.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,912.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.45
|
| Rate for Payer: PHCS Commercial |
$2,109.84
|
| Rate for Payer: United Healthcare All Payer |
$1,934.02
|
|
|
SABER BALLOON 4*30*150
|
Facility
|
OP
|
$2,197.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.33 |
| Max. Negotiated Rate |
$2,109.84 |
| Rate for Payer: Aetna Commercial |
$1,692.27
|
| Rate for Payer: Anthem Medicaid |
$755.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,714.24
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,824.13
|
| Rate for Payer: First Health Commercial |
$2,087.86
|
| Rate for Payer: Humana Commercial |
$1,868.09
|
| Rate for Payer: Humana KY Medicaid |
$755.81
|
| Rate for Payer: Kentucky WC Medicaid |
$763.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,802.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$770.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,648.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,912.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.45
|
| Rate for Payer: PHCS Commercial |
$2,109.84
|
| Rate for Payer: United Healthcare All Payer |
$1,934.02
|
|
|
SABER BALLOON 6*20*150
|
Facility
|
OP
|
$2,197.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.33 |
| Max. Negotiated Rate |
$2,109.84 |
| Rate for Payer: Aetna Commercial |
$1,692.27
|
| Rate for Payer: Anthem Medicaid |
$755.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,714.24
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,824.13
|
| Rate for Payer: First Health Commercial |
$2,087.86
|
| Rate for Payer: Humana Commercial |
$1,868.09
|
| Rate for Payer: Humana KY Medicaid |
$755.81
|
| Rate for Payer: Kentucky WC Medicaid |
$763.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,802.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$770.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,648.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,912.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.45
|
| Rate for Payer: PHCS Commercial |
$2,109.84
|
| Rate for Payer: United Healthcare All Payer |
$1,934.02
|
|
|
SABER BALLOON 6*20*150
|
Facility
|
IP
|
$2,197.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.33 |
| Max. Negotiated Rate |
$2,109.84 |
| Rate for Payer: Aetna Commercial |
$1,692.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,714.24
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,824.13
|
| Rate for Payer: First Health Commercial |
$2,087.86
|
| Rate for Payer: Humana Commercial |
$1,868.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,802.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,648.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,912.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.45
|
| Rate for Payer: PHCS Commercial |
$2,109.84
|
| Rate for Payer: United Healthcare All Payer |
$1,934.02
|
|
|
SABER BALLOON 6*25*150
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
