|
SHEL TRILOGY CLUSTER HOLE 66MM
|
Facility
|
IP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 66MM
|
Facility
|
OP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem Medicaid |
$2,701.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Humana KY Medicaid |
$2,701.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,728.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,755.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 68MM
|
Facility
|
IP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 68MM
|
Facility
|
OP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem Medicaid |
$2,701.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Humana KY Medicaid |
$2,701.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,728.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,755.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 70MM
|
Facility
|
IP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 70MM
|
Facility
|
OP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem Medicaid |
$2,701.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Humana KY Medicaid |
$2,701.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,728.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,755.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
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 |
$1,627.50 |
| 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
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem Medicaid |
$4,674.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Humana KY Medicaid |
$4,674.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,722.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
SHOCKWAVE BALLOON 2.5*40
|
Facility
|
IP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
SHOCKWAVE BALLOON 3*40
|
Facility
|
IP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
SHOCKWAVE BALLOON 3*40
|
Facility
|
OP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem Medicaid |
$4,674.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Humana KY Medicaid |
$4,674.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,722.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
SHOCKWAVE BALLOON 3.5*40
|
Facility
|
OP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem Medicaid |
$4,674.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Humana KY Medicaid |
$4,674.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,722.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
SHOCKWAVE BALLOON 3.5*40
|
Facility
|
IP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
SHOCKWAVE BALLOON 4*40
|
Facility
|
IP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
SHOCKWAVE BALLOON 4*40
|
Facility
|
OP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem Medicaid |
$4,674.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Humana KY Medicaid |
$4,674.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,722.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
SHOCKWAVE BALLOON 4.5*60
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
SHOCKWAVE BALLOON 4.5*60
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
SHOCKWAVE BALLOON 5.5*60
|
Facility
|
IP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
SHOCKWAVE BALLOON 5.5*60
|
Facility
|
OP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem Medicaid |
$5,903.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Humana KY Medicaid |
$5,903.04
|
| Rate for Payer: Kentucky WC Medicaid |
$5,963.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,021.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
SHOCKWAVE BALLOON 5*60
|
Facility
|
OP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem Medicaid |
$5,903.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Humana KY Medicaid |
$5,903.04
|
| Rate for Payer: Kentucky WC Medicaid |
$5,963.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,021.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
SHOCKWAVE BALLOON 5*60
|
Facility
|
IP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
SHOCKWAVE BALLOON 6.5*60
|
Facility
|
OP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem Medicaid |
$5,903.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Humana KY Medicaid |
$5,903.04
|
| Rate for Payer: Kentucky WC Medicaid |
$5,963.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,021.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
SHOCKWAVE BALLOON 6.5*60
|
Facility
|
IP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
SHOCKWAVE BALLOON 6*60
|
Facility
|
IP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
SHOCKWAVE BALLOON 6*60
|
Facility
|
OP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem Medicaid |
$5,903.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Humana KY Medicaid |
$5,903.04
|
| Rate for Payer: Kentucky WC Medicaid |
$5,963.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,021.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
