|
STERNAL TALON THRACIC XSM 14MM
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
ST FLUSH CATH 65CM
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ST FLUSH CATH 65CM
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ST FLUSH CATH 90CM
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ST FLUSH CATH 90CM
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
STIMULATOR PERC IMPLANTATION
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 63650
|
| Hospital Charge Code |
76102305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.44 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Aetna Commercial |
$650.19
|
| Rate for Payer: Ambetter Exchange |
$391.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$338.44
|
| Rate for Payer: Anthem Medicaid |
$433.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$391.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$469.90
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$629.85
|
| Rate for Payer: Healthspan PPO |
$507.65
|
| Rate for Payer: Humana Medicaid |
$433.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$391.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$441.92
|
| Rate for Payer: Molina Healthcare Passport |
$433.25
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$509.05
|
| Rate for Payer: UHCCP Medicaid |
$355.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$437.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$391.58
|
|
|
STIMULATOR PERC IMPLANTATION
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 63650
|
| Hospital Charge Code |
76102305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
STIMULATOR PERC IMPLANTATION
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 63650
|
| Hospital Charge Code |
76102305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$8,489.59 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,063.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,489.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,186.39
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Humana Medicare Advantage |
$6,063.99
|
| Rate for Payer: Kentucky WC Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
STIMULATOR PERC IMPLANTATION(P
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 63650
|
| Hospital Charge Code |
761P2305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.44 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Aetna Commercial |
$650.19
|
| Rate for Payer: Ambetter Exchange |
$391.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$338.44
|
| Rate for Payer: Anthem Medicaid |
$433.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$391.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$469.90
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$629.85
|
| Rate for Payer: Healthspan PPO |
$507.65
|
| Rate for Payer: Humana Medicaid |
$433.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$391.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$441.92
|
| Rate for Payer: Molina Healthcare Passport |
$433.25
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$509.05
|
| Rate for Payer: UHCCP Medicaid |
$355.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$437.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$391.58
|
|
|
STIMULATOR WIRELESS EXT NEURO
|
Facility
|
OP
|
$8,219.50
|
|
|
Service Code
|
HCPCS C1767
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,465.85 |
| Max. Negotiated Rate |
$7,890.72 |
| Rate for Payer: Aetna Commercial |
$6,329.02
|
| Rate for Payer: Anthem Medicaid |
$2,826.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.21
|
| Rate for Payer: Cash Price |
$4,109.75
|
| Rate for Payer: Cigna Commercial |
$6,822.19
|
| Rate for Payer: First Health Commercial |
$7,808.52
|
| Rate for Payer: Humana Commercial |
$6,986.57
|
| Rate for Payer: Humana KY Medicaid |
$2,826.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,855.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,739.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,065.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,465.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,883.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,164.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,575.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,150.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,671.45
|
| Rate for Payer: PHCS Commercial |
$7,890.72
|
| Rate for Payer: United Healthcare All Payer |
$7,233.16
|
|
|
STIMULATOR WIRELESS EXT NEURO
|
Facility
|
IP
|
$8,219.50
|
|
|
Service Code
|
HCPCS C1767
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,465.85 |
| Max. Negotiated Rate |
$7,890.72 |
| Rate for Payer: Aetna Commercial |
$6,329.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.21
|
| Rate for Payer: Cash Price |
$4,109.75
|
| Rate for Payer: Cigna Commercial |
$6,822.19
|
| Rate for Payer: First Health Commercial |
$7,808.52
|
| Rate for Payer: Humana Commercial |
$6,986.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,739.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,065.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,465.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,164.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,575.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,150.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,671.45
|
| Rate for Payer: PHCS Commercial |
$7,890.72
|
| Rate for Payer: United Healthcare All Payer |
$7,233.16
|
|
|
STINGRAY BALLOON
|
Facility
|
IP
|
$7,795.63
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,338.69 |
| Max. Negotiated Rate |
$7,483.80 |
| Rate for Payer: Aetna Commercial |
$6,002.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,080.59
|
| Rate for Payer: Cash Price |
$3,897.81
|
| Rate for Payer: Cigna Commercial |
$6,470.37
|
| Rate for Payer: First Health Commercial |
$7,405.85
|
| Rate for Payer: Humana Commercial |
$6,626.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,392.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,753.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,338.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,860.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,846.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,236.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,782.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,378.98
|
| Rate for Payer: PHCS Commercial |
$7,483.80
|
| Rate for Payer: United Healthcare All Payer |
$6,860.15
|
|
|
STINGRAY BALLOON
|
Facility
|
OP
|
$7,795.63
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,338.69 |
| Max. Negotiated Rate |
$7,483.80 |
| Rate for Payer: Aetna Commercial |
$6,002.64
|
| Rate for Payer: Anthem Medicaid |
$2,680.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,080.59
|
| Rate for Payer: Cash Price |
$3,897.81
|
| Rate for Payer: Cigna Commercial |
$6,470.37
|
| Rate for Payer: First Health Commercial |
$7,405.85
|
| Rate for Payer: Humana Commercial |
$6,626.29
|
| Rate for Payer: Humana KY Medicaid |
$2,680.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,708.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,392.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,753.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,338.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,734.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,860.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,846.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,236.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,782.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,378.98
|
| Rate for Payer: PHCS Commercial |
$7,483.80
|
| Rate for Payer: United Healthcare All Payer |
$6,860.15
|
|
|
STINGRAY GUIDEWIRE 185CM
|
Facility
|
OP
|
$3,328.93
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.68 |
| Max. Negotiated Rate |
$3,195.77 |
| Rate for Payer: Aetna Commercial |
$2,563.28
|
| Rate for Payer: Anthem Medicaid |
$1,144.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,596.57
|
| Rate for Payer: Cash Price |
$1,664.46
|
| Rate for Payer: Cigna Commercial |
$2,763.01
|
| Rate for Payer: First Health Commercial |
$3,162.48
|
| Rate for Payer: Humana Commercial |
$2,829.59
|
| Rate for Payer: Humana KY Medicaid |
$1,144.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,156.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,729.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,456.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,929.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,496.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,896.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,296.96
|
| Rate for Payer: PHCS Commercial |
$3,195.77
|
| Rate for Payer: United Healthcare All Payer |
$2,929.46
|
|
|
STINGRAY GUIDEWIRE 185CM
|
Facility
|
IP
|
$3,328.93
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.68 |
| Max. Negotiated Rate |
$3,195.77 |
| Rate for Payer: Aetna Commercial |
$2,563.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,596.57
|
| Rate for Payer: Cash Price |
$1,664.46
|
| Rate for Payer: Cigna Commercial |
$2,763.01
|
| Rate for Payer: First Health Commercial |
$3,162.48
|
| Rate for Payer: Humana Commercial |
$2,829.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,729.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,456.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,929.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,496.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,896.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,296.96
|
| Rate for Payer: PHCS Commercial |
$3,195.77
|
| Rate for Payer: United Healthcare All Payer |
$2,929.46
|
|
|
STINGRAY GUIDEWIRE 300CM
|
Facility
|
IP
|
$3,328.93
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.68 |
| Max. Negotiated Rate |
$3,195.77 |
| Rate for Payer: Aetna Commercial |
$2,563.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,596.57
|
| Rate for Payer: Cash Price |
$1,664.46
|
| Rate for Payer: Cigna Commercial |
$2,763.01
|
| Rate for Payer: First Health Commercial |
$3,162.48
|
| Rate for Payer: Humana Commercial |
$2,829.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,729.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,456.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,929.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,496.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,896.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,296.96
|
| Rate for Payer: PHCS Commercial |
$3,195.77
|
| Rate for Payer: United Healthcare All Payer |
$2,929.46
|
|
|
STINGRAY GUIDEWIRE 300CM
|
Facility
|
OP
|
$3,328.93
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.68 |
| Max. Negotiated Rate |
$3,195.77 |
| Rate for Payer: Aetna Commercial |
$2,563.28
|
| Rate for Payer: Anthem Medicaid |
$1,144.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,596.57
|
| Rate for Payer: Cash Price |
$1,664.46
|
| Rate for Payer: Cigna Commercial |
$2,763.01
|
| Rate for Payer: First Health Commercial |
$3,162.48
|
| Rate for Payer: Humana Commercial |
$2,829.59
|
| Rate for Payer: Humana KY Medicaid |
$1,144.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,156.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,729.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,456.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,929.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,496.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,896.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,296.96
|
| Rate for Payer: PHCS Commercial |
$3,195.77
|
| Rate for Payer: United Healthcare All Payer |
$2,929.46
|
|
|
STONEMASTER V BD 25MM BALLOON
|
Facility
|
OP
|
$3,777.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,133.25 |
| Max. Negotiated Rate |
$3,626.40 |
| Rate for Payer: Aetna Commercial |
$2,908.68
|
| Rate for Payer: Anthem Medicaid |
$1,299.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.45
|
| Rate for Payer: Cash Price |
$1,888.75
|
| Rate for Payer: Cigna Commercial |
$3,135.32
|
| Rate for Payer: First Health Commercial |
$3,588.62
|
| Rate for Payer: Humana Commercial |
$3,210.88
|
| Rate for Payer: Humana KY Medicaid |
$1,299.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,312.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,325.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.47
|
| Rate for Payer: PHCS Commercial |
$3,626.40
|
| Rate for Payer: United Healthcare All Payer |
$3,324.20
|
|
|
STONEMASTER V BD 25MM BALLOON
|
Facility
|
IP
|
$3,777.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,133.25 |
| Max. Negotiated Rate |
$3,626.40 |
| Rate for Payer: Aetna Commercial |
$2,908.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.45
|
| Rate for Payer: Cash Price |
$1,888.75
|
| Rate for Payer: Cigna Commercial |
$3,135.32
|
| Rate for Payer: First Health Commercial |
$3,588.62
|
| Rate for Payer: Humana Commercial |
$3,210.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.47
|
| Rate for Payer: PHCS Commercial |
$3,626.40
|
| Rate for Payer: United Healthcare All Payer |
$3,324.20
|
|
|
STOOL SPEC FAT STAIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 89125
|
| Hospital Charge Code |
30001549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$5.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.88
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$5.88
|
| Rate for Payer: Humana Medicare Advantage |
$5.88
|
| Rate for Payer: Kentucky WC Medicaid |
$5.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
STOOL SPEC FAT STAIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 89125
|
| Hospital Charge Code |
30001549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.18
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
STRAIGHT GC 7F 90CM
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem Medicaid |
$388.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Humana KY Medicaid |
$388.61
|
| Rate for Payer: Kentucky WC Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
STRAIGHT GC 7F 90CM
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
STRAIGHT GUIDE 6F 90CM
|
Facility
|
IP
|
$1,740.42
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.13 |
| Max. Negotiated Rate |
$1,670.80 |
| Rate for Payer: Aetna Commercial |
$1,340.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.53
|
| Rate for Payer: Cash Price |
$870.21
|
| Rate for Payer: Cigna Commercial |
$1,444.55
|
| Rate for Payer: First Health Commercial |
$1,653.40
|
| Rate for Payer: Humana Commercial |
$1,479.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,427.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,514.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.89
|
| Rate for Payer: PHCS Commercial |
$1,670.80
|
| Rate for Payer: United Healthcare All Payer |
$1,531.57
|
|
|
STRAIGHT GUIDE 6F 90CM
|
Facility
|
OP
|
$1,740.42
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.13 |
| Max. Negotiated Rate |
$1,670.80 |
| Rate for Payer: Aetna Commercial |
$1,340.12
|
| Rate for Payer: Anthem Medicaid |
$598.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.53
|
| Rate for Payer: Cash Price |
$870.21
|
| Rate for Payer: Cigna Commercial |
$1,444.55
|
| Rate for Payer: First Health Commercial |
$1,653.40
|
| Rate for Payer: Humana Commercial |
$1,479.36
|
| Rate for Payer: Humana KY Medicaid |
$598.53
|
| Rate for Payer: Kentucky WC Medicaid |
$604.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,427.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,514.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.89
|
| Rate for Payer: PHCS Commercial |
$1,670.80
|
| Rate for Payer: United Healthcare All Payer |
$1,531.57
|
|
