|
BALLOON CATHETER BVCS6180
|
Facility
|
OP
|
$1,718.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$515.40 |
| Max. Negotiated Rate |
$1,649.28 |
| Rate for Payer: Aetna Commercial |
$1,322.86
|
| Rate for Payer: Anthem Medicaid |
$590.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,340.04
|
| Rate for Payer: Cash Price |
$859.00
|
| Rate for Payer: Cigna Commercial |
$1,425.94
|
| Rate for Payer: First Health Commercial |
$1,632.10
|
| Rate for Payer: Humana Commercial |
$1,460.30
|
| Rate for Payer: Humana KY Medicaid |
$590.82
|
| Rate for Payer: Kentucky WC Medicaid |
$596.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$602.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,494.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,185.42
|
| Rate for Payer: PHCS Commercial |
$1,649.28
|
| Rate for Payer: United Healthcare All Payer |
$1,511.84
|
|
|
BALLOON CATH MLD OC 10-37M 10F
|
Facility
|
OP
|
$4,152.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,245.75 |
| Max. Negotiated Rate |
$3,986.40 |
| Rate for Payer: Aetna Commercial |
$3,197.43
|
| Rate for Payer: Anthem Medicaid |
$1,428.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,238.95
|
| Rate for Payer: Cash Price |
$2,076.25
|
| Rate for Payer: Cigna Commercial |
$3,446.57
|
| Rate for Payer: First Health Commercial |
$3,944.88
|
| Rate for Payer: Humana Commercial |
$3,529.62
|
| Rate for Payer: Humana KY Medicaid |
$1,428.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,442.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,405.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,064.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,245.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,456.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,654.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,114.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,322.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,612.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,865.22
|
| Rate for Payer: PHCS Commercial |
$3,986.40
|
| Rate for Payer: United Healthcare All Payer |
$3,654.20
|
|
|
BALLOON CATH MLD OC 10-37M 10F
|
Facility
|
IP
|
$4,152.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,245.75 |
| Max. Negotiated Rate |
$3,986.40 |
| Rate for Payer: Aetna Commercial |
$3,197.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,238.95
|
| Rate for Payer: Cash Price |
$2,076.25
|
| Rate for Payer: Cigna Commercial |
$3,446.57
|
| Rate for Payer: First Health Commercial |
$3,944.88
|
| Rate for Payer: Humana Commercial |
$3,529.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,405.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,064.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,245.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,654.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,114.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,322.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,612.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,865.22
|
| Rate for Payer: PHCS Commercial |
$3,986.40
|
| Rate for Payer: United Healthcare All Payer |
$3,654.20
|
|
|
BALLOON CRE PUL 10-11-12MM*3.0
|
Facility
|
OP
|
$3,275.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$982.50 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem Medicaid |
$1,126.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Humana KY Medicaid |
$1,126.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,137.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,148.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
BALLOON CRE PUL 10-11-12MM*3.0
|
Facility
|
IP
|
$3,275.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$982.50 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
BALLOON CRE PUL 18-19-20MM*5.5
|
Facility
|
OP
|
$3,275.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$982.50 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem Medicaid |
$1,126.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Humana KY Medicaid |
$1,126.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,137.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,148.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
BALLOON CRE PUL 18-19-20MM*5.5
|
Facility
|
IP
|
$3,275.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$982.50 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
BALLOON CRE PULM 12-13.5-15 3.
|
Facility
|
IP
|
$3,181.25
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$954.38 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Aetna Commercial |
$2,449.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,481.38
|
| Rate for Payer: Cash Price |
$1,590.62
|
| Rate for Payer: Cigna Commercial |
$2,640.44
|
| Rate for Payer: First Health Commercial |
$3,022.19
|
| Rate for Payer: Humana Commercial |
$2,704.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,608.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,347.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,799.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,545.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,767.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.06
|
| Rate for Payer: PHCS Commercial |
$3,054.00
|
| Rate for Payer: United Healthcare All Payer |
$2,799.50
|
|
|
BALLOON CRE PULM 12-13.5-15 3.
|
Facility
|
OP
|
$3,181.25
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$954.38 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Aetna Commercial |
$2,449.56
|
| Rate for Payer: Anthem Medicaid |
$1,094.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,481.38
|
| Rate for Payer: Cash Price |
$1,590.62
|
| Rate for Payer: Cigna Commercial |
$2,640.44
|
| Rate for Payer: First Health Commercial |
$3,022.19
|
| Rate for Payer: Humana Commercial |
$2,704.06
|
| Rate for Payer: Humana KY Medicaid |
$1,094.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,105.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,608.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,347.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,115.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,799.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,545.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,767.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.06
|
| Rate for Payer: PHCS Commercial |
$3,054.00
|
| Rate for Payer: United Healthcare All Payer |
$2,799.50
|
|
|
BALLOON DILATION 6.0*40 40CM
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem Medicaid |
$695.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Humana KY Medicaid |
$695.37
|
| Rate for Payer: Kentucky WC Medicaid |
$702.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
BALLOON DILATION 6.0*40 40CM
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
BALLOON DILATOR 10-11-12 5847
|
Facility
|
OP
|
$2,127.03
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.11 |
| Max. Negotiated Rate |
$2,041.95 |
| Rate for Payer: Aetna Commercial |
$1,637.81
|
| Rate for Payer: Anthem Medicaid |
$731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.08
|
| Rate for Payer: Cash Price |
$1,063.52
|
| Rate for Payer: Cigna Commercial |
$1,765.43
|
| Rate for Payer: First Health Commercial |
$2,020.68
|
| Rate for Payer: Humana Commercial |
$1,807.98
|
| Rate for Payer: Humana KY Medicaid |
$731.49
|
| Rate for Payer: Kentucky WC Medicaid |
$738.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,701.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.65
|
| Rate for Payer: PHCS Commercial |
$2,041.95
|
| Rate for Payer: United Healthcare All Payer |
$1,871.79
|
|
|
BALLOON DILATOR 10-11-12 5847
|
Facility
|
IP
|
$2,127.03
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.11 |
| Max. Negotiated Rate |
$2,041.95 |
| Rate for Payer: Aetna Commercial |
$1,637.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.08
|
| Rate for Payer: Cash Price |
$1,063.52
|
| Rate for Payer: Cigna Commercial |
$1,765.43
|
| Rate for Payer: First Health Commercial |
$2,020.68
|
| Rate for Payer: Humana Commercial |
$1,807.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,701.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.65
|
| Rate for Payer: PHCS Commercial |
$2,041.95
|
| Rate for Payer: United Healthcare All Payer |
$1,871.79
|
|
|
BALLOON DILATOR 12-13.5-15 584
|
Facility
|
OP
|
$2,127.03
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.11 |
| Max. Negotiated Rate |
$2,041.95 |
| Rate for Payer: Aetna Commercial |
$1,637.81
|
| Rate for Payer: Anthem Medicaid |
$731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.08
|
| Rate for Payer: Cash Price |
$1,063.52
|
| Rate for Payer: Cigna Commercial |
$1,765.43
|
| Rate for Payer: First Health Commercial |
$2,020.68
|
| Rate for Payer: Humana Commercial |
$1,807.98
|
| Rate for Payer: Humana KY Medicaid |
$731.49
|
| Rate for Payer: Kentucky WC Medicaid |
$738.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,701.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.65
|
| Rate for Payer: PHCS Commercial |
$2,041.95
|
| Rate for Payer: United Healthcare All Payer |
$1,871.79
|
|
|
BALLOON DILATOR 12-13.5-15 584
|
Facility
|
IP
|
$2,127.03
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.11 |
| Max. Negotiated Rate |
$2,041.95 |
| Rate for Payer: Aetna Commercial |
$1,637.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.08
|
| Rate for Payer: Cash Price |
$1,063.52
|
| Rate for Payer: Cigna Commercial |
$1,765.43
|
| Rate for Payer: First Health Commercial |
$2,020.68
|
| Rate for Payer: Humana Commercial |
$1,807.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,701.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.65
|
| Rate for Payer: PHCS Commercial |
$2,041.95
|
| Rate for Payer: United Healthcare All Payer |
$1,871.79
|
|
|
BALLOON DILATOR 15-16.5-18 584
|
Facility
|
IP
|
$2,127.03
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.11 |
| Max. Negotiated Rate |
$2,041.95 |
| Rate for Payer: Aetna Commercial |
$1,637.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.08
|
| Rate for Payer: Cash Price |
$1,063.52
|
| Rate for Payer: Cigna Commercial |
$1,765.43
|
| Rate for Payer: First Health Commercial |
$2,020.68
|
| Rate for Payer: Humana Commercial |
$1,807.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,701.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.65
|
| Rate for Payer: PHCS Commercial |
$2,041.95
|
| Rate for Payer: United Healthcare All Payer |
$1,871.79
|
|
|
BALLOON DILATOR 15-16.5-18 584
|
Facility
|
OP
|
$2,127.03
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.11 |
| Max. Negotiated Rate |
$2,041.95 |
| Rate for Payer: Aetna Commercial |
$1,637.81
|
| Rate for Payer: Anthem Medicaid |
$731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.08
|
| Rate for Payer: Cash Price |
$1,063.52
|
| Rate for Payer: Cigna Commercial |
$1,765.43
|
| Rate for Payer: First Health Commercial |
$2,020.68
|
| Rate for Payer: Humana Commercial |
$1,807.98
|
| Rate for Payer: Humana KY Medicaid |
$731.49
|
| Rate for Payer: Kentucky WC Medicaid |
$738.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,701.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.65
|
| Rate for Payer: PHCS Commercial |
$2,041.95
|
| Rate for Payer: United Healthcare All Payer |
$1,871.79
|
|
|
BALLOON DILATOR 6-7-8 5845
|
Facility
|
IP
|
$2,127.03
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.11 |
| Max. Negotiated Rate |
$2,041.95 |
| Rate for Payer: Aetna Commercial |
$1,637.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.08
|
| Rate for Payer: Cash Price |
$1,063.52
|
| Rate for Payer: Cigna Commercial |
$1,765.43
|
| Rate for Payer: First Health Commercial |
$2,020.68
|
| Rate for Payer: Humana Commercial |
$1,807.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,701.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.65
|
| Rate for Payer: PHCS Commercial |
$2,041.95
|
| Rate for Payer: United Healthcare All Payer |
$1,871.79
|
|
|
BALLOON DILATOR 6-7-8 5845
|
Facility
|
OP
|
$2,127.03
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.11 |
| Max. Negotiated Rate |
$2,041.95 |
| Rate for Payer: Aetna Commercial |
$1,637.81
|
| Rate for Payer: Anthem Medicaid |
$731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.08
|
| Rate for Payer: Cash Price |
$1,063.52
|
| Rate for Payer: Cigna Commercial |
$1,765.43
|
| Rate for Payer: First Health Commercial |
$2,020.68
|
| Rate for Payer: Humana Commercial |
$1,807.98
|
| Rate for Payer: Humana KY Medicaid |
$731.49
|
| Rate for Payer: Kentucky WC Medicaid |
$738.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,701.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.65
|
| Rate for Payer: PHCS Commercial |
$2,041.95
|
| Rate for Payer: United Healthcare All Payer |
$1,871.79
|
|
|
BALLOON DILATOR 8-9-10 5846
|
Facility
|
OP
|
$2,146.45
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$643.93 |
| Max. Negotiated Rate |
$2,060.59 |
| Rate for Payer: Aetna Commercial |
$1,652.77
|
| Rate for Payer: Anthem Medicaid |
$738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,674.23
|
| Rate for Payer: Cash Price |
$1,073.22
|
| Rate for Payer: Cigna Commercial |
$1,781.55
|
| Rate for Payer: First Health Commercial |
$2,039.13
|
| Rate for Payer: Humana Commercial |
$1,824.48
|
| Rate for Payer: Humana KY Medicaid |
$738.16
|
| Rate for Payer: Kentucky WC Medicaid |
$745.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,760.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,584.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$752.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,888.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,609.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,867.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.05
|
| Rate for Payer: PHCS Commercial |
$2,060.59
|
| Rate for Payer: United Healthcare All Payer |
$1,888.88
|
|
|
BALLOON DILATOR 8-9-10 5846
|
Facility
|
IP
|
$2,146.45
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$643.93 |
| Max. Negotiated Rate |
$2,060.59 |
| Rate for Payer: Aetna Commercial |
$1,652.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,674.23
|
| Rate for Payer: Cash Price |
$1,073.22
|
| Rate for Payer: Cigna Commercial |
$1,781.55
|
| Rate for Payer: First Health Commercial |
$2,039.13
|
| Rate for Payer: Humana Commercial |
$1,824.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,760.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,584.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,888.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,609.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,867.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.05
|
| Rate for Payer: PHCS Commercial |
$2,060.59
|
| Rate for Payer: United Healthcare All Payer |
$1,888.88
|
|
|
BALLOON KYPHOPLASTY BUNDLE
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BALLOON KYPHOPLASTY BUNDLE
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BALLOON RETRIEVAL 11.5M RAP EX
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
|
BALLOON RETRIEVAL 11.5M RAP EX
|
Facility
|
OP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem Medicaid |
$630.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Humana KY Medicaid |
$630.02
|
| Rate for Payer: Kentucky WC Medicaid |
$636.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
