|
SHO ARTHRS SRG DECOMPRESSION
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 29999
|
| Hospital Charge Code |
76102769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,325.00
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,627.50
|
| Rate for Payer: UHCCP Medicaid |
$813.75
|
|
|
SHOCKWAVE BALLOON 2.5*40
|
Facility
|
OP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem Medicaid |
$4,586.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Humana KY Medicaid |
$4,586.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,633.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,678.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
SHOCKWAVE BALLOON 2.5*40
|
Facility
|
IP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
SHOCKWAVE BALLOON 3*40
|
Facility
|
IP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
SHOCKWAVE BALLOON 3*40
|
Facility
|
OP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem Medicaid |
$4,586.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Humana KY Medicaid |
$4,586.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,633.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,678.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
SHOCKWAVE BALLOON 3.5*40
|
Facility
|
IP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
SHOCKWAVE BALLOON 3.5*40
|
Facility
|
OP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem Medicaid |
$4,586.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Humana KY Medicaid |
$4,586.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,633.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,678.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
SHOCKWAVE BALLOON 4*40
|
Facility
|
OP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem Medicaid |
$4,586.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Humana KY Medicaid |
$4,586.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,633.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,678.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
SHOCKWAVE BALLOON 4*40
|
Facility
|
IP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
SHOCKWAVE BALLOON 4.5*60
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
SHOCKWAVE BALLOON 4.5*60
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
SHOCKWAVE BALLOON 5.5*60
|
Facility
|
OP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem Medicaid |
$5,715.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Humana KY Medicaid |
$5,715.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,773.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,830.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE BALLOON 5.5*60
|
Facility
|
IP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE BALLOON 5*60
|
Facility
|
OP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem Medicaid |
$5,715.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Humana KY Medicaid |
$5,715.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,773.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,830.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE BALLOON 5*60
|
Facility
|
IP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE BALLOON 6.5*60
|
Facility
|
IP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE BALLOON 6.5*60
|
Facility
|
OP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem Medicaid |
$5,715.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Humana KY Medicaid |
$5,715.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,773.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,830.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE BALLOON 6*60
|
Facility
|
IP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE BALLOON 6*60
|
Facility
|
OP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem Medicaid |
$5,715.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Humana KY Medicaid |
$5,715.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,773.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,830.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE BALLOON 7*60
|
Facility
|
IP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE BALLOON 7*60
|
Facility
|
OP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem Medicaid |
$5,715.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Humana KY Medicaid |
$5,715.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,773.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,830.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE BALLOON 8*60
|
Facility
|
IP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE BALLOON 8*60
|
Facility
|
OP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem Medicaid |
$5,715.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Humana KY Medicaid |
$5,715.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,773.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,830.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
SHOCKWAVE C2 BALLOON 2.5*12
|
Facility
|
OP
|
$21,955.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.15 |
| Max. Negotiated Rate |
$21,076.80 |
| Rate for Payer: Aetna Commercial |
$16,905.35
|
| Rate for Payer: Anthem Medicaid |
$7,550.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,124.90
|
| Rate for Payer: Cash Price |
$10,977.50
|
| Rate for Payer: Cigna Commercial |
$18,222.65
|
| Rate for Payer: First Health Commercial |
$20,857.25
|
| Rate for Payer: Humana Commercial |
$18,661.75
|
| Rate for Payer: Humana KY Medicaid |
$7,550.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,627.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,003.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,202.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,586.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,701.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,320.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,466.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,391.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,854.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,806.05
|
| Rate for Payer: PHCS Commercial |
$21,076.80
|
| Rate for Payer: United Healthcare All Payer |
$19,320.40
|
|
|
SHOCKWAVE C2 BALLOON 2.5*12
|
Facility
|
IP
|
$21,955.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.15 |
| Max. Negotiated Rate |
$21,076.80 |
| Rate for Payer: Aetna Commercial |
$16,905.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,124.90
|
| Rate for Payer: Cash Price |
$10,977.50
|
| Rate for Payer: Cigna Commercial |
$18,222.65
|
| Rate for Payer: First Health Commercial |
$20,857.25
|
| Rate for Payer: Humana Commercial |
$18,661.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,003.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,202.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,586.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,320.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,466.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,391.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,854.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,806.05
|
| Rate for Payer: PHCS Commercial |
$21,076.80
|
| Rate for Payer: United Healthcare All Payer |
$19,320.40
|
|
