|
SHOCKWAVE BALLOON 7*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 7*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 8*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 8*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 C2 BALLOON 2.5*12
|
Facility
|
IP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
SHOCKWAVE C2 BALLOON 2.5*12
|
Facility
|
OP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem Medicaid |
$7,780.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Humana KY Medicaid |
$7,780.74
|
| Rate for Payer: Kentucky WC Medicaid |
$7,859.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,936.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
SHOCKWAVE C2 BALLOON 3*12
|
Facility
|
OP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem Medicaid |
$7,780.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Humana KY Medicaid |
$7,780.74
|
| Rate for Payer: Kentucky WC Medicaid |
$7,859.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,936.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
SHOCKWAVE C2 BALLOON 3*12
|
Facility
|
IP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
SHOCKWAVE C2 BALLOON 3.5*12
|
Facility
|
IP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
SHOCKWAVE C2 BALLOON 3.5*12
|
Facility
|
OP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem Medicaid |
$7,780.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Humana KY Medicaid |
$7,780.74
|
| Rate for Payer: Kentucky WC Medicaid |
$7,859.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,936.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
SHOCKWAVE C2 BALLOON 4*12
|
Facility
|
IP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
SHOCKWAVE C2 BALLOON 4*12
|
Facility
|
OP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem Medicaid |
$7,780.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Humana KY Medicaid |
$7,780.74
|
| Rate for Payer: Kentucky WC Medicaid |
$7,859.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,936.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
SHOCKWAVE E8 2.5 X 80
|
Facility
|
IP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
SHOCKWAVE E8 2.5 X 80
|
Facility
|
OP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem Medicaid |
$7,780.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Humana KY Medicaid |
$7,780.74
|
| Rate for Payer: Kentucky WC Medicaid |
$7,859.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,936.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
SHORTEN RADIUS OR ULNA
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
76100610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SHORTEN RADIUS OR ULNA
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
76100610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,578.24 |
| Rate for Payer: Aetna Commercial |
$1,216.86
|
| Rate for Payer: Ambetter Exchange |
$733.84
|
| Rate for Payer: Anthem Medicaid |
$562.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$733.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$733.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$880.61
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,578.24
|
| Rate for Payer: Healthspan PPO |
$1,102.22
|
| Rate for Payer: Humana Medicaid |
$562.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$990.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$733.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$733.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$573.29
|
| Rate for Payer: Molina Healthcare Passport |
$562.05
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$953.99
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$567.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$733.84
|
|
|
SHORTEN RADIUS OR ULNA
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
76100610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.24 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SHORTEN RADIUS OR ULNA(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
761P0610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,578.24 |
| Rate for Payer: Aetna Commercial |
$1,216.86
|
| Rate for Payer: Ambetter Exchange |
$733.84
|
| Rate for Payer: Anthem Medicaid |
$562.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$733.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$733.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$880.61
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,578.24
|
| Rate for Payer: Healthspan PPO |
$1,102.22
|
| Rate for Payer: Humana Medicaid |
$562.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$990.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$733.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$733.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$573.29
|
| Rate for Payer: Molina Healthcare Passport |
$562.05
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$953.99
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$567.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$733.84
|
|
|
SHOULDER ARTHROSCOPY DX
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS 29805
|
| Hospital Charge Code |
76101074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$643.20 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.30
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
SHOULDER ARTHROSCOPY DX
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 29805
|
| Hospital Charge Code |
76101074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.50 |
| Max. Negotiated Rate |
$760.85 |
| Rate for Payer: Aetna Commercial |
$685.25
|
| Rate for Payer: Ambetter Exchange |
$449.00
|
| Rate for Payer: Anthem Medicaid |
$273.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$449.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$449.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$538.80
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$760.85
|
| Rate for Payer: Healthspan PPO |
$620.69
|
| Rate for Payer: Humana Medicaid |
$273.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$449.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$449.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.09
|
| Rate for Payer: Molina Healthcare Passport |
$273.62
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.70
|
| Rate for Payer: UHCCP Medicaid |
$234.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$449.00
|
|
|
SHOULDER ARTHROSCOPY DX
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS 29805
|
| Hospital Charge Code |
76101074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem Medicaid |
$230.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Humana KY Medicaid |
$230.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$232.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$235.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.30
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
SHOULDER ARTHROSCOPY DX(P
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 29805
|
| Hospital Charge Code |
761P1074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.50 |
| Max. Negotiated Rate |
$760.85 |
| Rate for Payer: Aetna Commercial |
$685.25
|
| Rate for Payer: Ambetter Exchange |
$449.00
|
| Rate for Payer: Anthem Medicaid |
$273.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$449.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$449.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$538.80
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$760.85
|
| Rate for Payer: Healthspan PPO |
$620.69
|
| Rate for Payer: Humana Medicaid |
$273.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$449.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$449.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.09
|
| Rate for Payer: Molina Healthcare Passport |
$273.62
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.70
|
| Rate for Payer: UHCCP Medicaid |
$234.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$449.00
|
|
|
SHOULDER ARTHROSCOPY/SURGER(P
|
Professional
|
Both
|
$1,536.00
|
|
|
Service Code
|
HCPCS 29806
|
| Hospital Charge Code |
761P1075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.60 |
| Max. Negotiated Rate |
$1,726.69 |
| Rate for Payer: Aetna Commercial |
$1,581.02
|
| Rate for Payer: Ambetter Exchange |
$1,004.83
|
| Rate for Payer: Anthem Medicaid |
$756.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,004.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,004.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,205.80
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,726.69
|
| Rate for Payer: Healthspan PPO |
$1,432.06
|
| Rate for Payer: Humana Medicaid |
$756.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,325.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,004.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$771.36
|
| Rate for Payer: Molina Healthcare Passport |
$756.24
|
| Rate for Payer: Multiplan PHCS |
$921.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,306.28
|
| Rate for Payer: UHCCP Medicaid |
$537.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$763.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,004.83
|
|
|
SHOULDER ARTHROSCOPY/SURGER(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 29821
|
| Hospital Charge Code |
761P1079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.59 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$868.67
|
| Rate for Payer: Ambetter Exchange |
$566.36
|
| Rate for Payer: Anthem Medicaid |
$524.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$566.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$566.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$679.63
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$959.45
|
| Rate for Payer: Healthspan PPO |
$786.83
|
| Rate for Payer: Humana Medicaid |
$524.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$732.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$566.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$535.08
|
| Rate for Payer: Molina Healthcare Passport |
$524.59
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$736.27
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$529.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$566.36
|
|
|
SHOULDER ARTHROSCOPY/SURGER(P
|
Professional
|
Both
|
$2,057.00
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
761P1081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.11 |
| Max. Negotiated Rate |
$1,234.20 |
| Rate for Payer: Aetna Commercial |
$922.86
|
| Rate for Payer: Ambetter Exchange |
$564.52
|
| Rate for Payer: Anthem Medicaid |
$557.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$564.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$564.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$677.42
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cigna Commercial |
$1,017.50
|
| Rate for Payer: Healthspan PPO |
$835.91
|
| Rate for Payer: Humana Medicaid |
$557.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$776.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$564.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$568.25
|
| Rate for Payer: Molina Healthcare Passport |
$557.11
|
| Rate for Payer: Multiplan PHCS |
$1,234.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$733.88
|
| Rate for Payer: UHCCP Medicaid |
$719.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$562.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$564.52
|
|
