|
WOLVERINE CUT. BALLOON 2*10
|
Facility
|
OP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem Medicaid |
$1,532.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Humana KY Medicaid |
$1,532.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 2*15
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
WOLVERINE CUT. BALLOON 2*15
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
WOLVERINE CUT. BALLOON 2.50*6
|
Facility
|
OP
|
$4,601.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.13 |
| Max. Negotiated Rate |
$4,416.96 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Anthem Medicaid |
$1,582.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.78
|
| Rate for Payer: Cash Price |
$2,300.50
|
| Rate for Payer: Cigna Commercial |
$3,818.83
|
| Rate for Payer: First Health Commercial |
$4,370.95
|
| Rate for Payer: Humana Commercial |
$3,910.85
|
| Rate for Payer: Humana KY Medicaid |
$1,582.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,598.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,395.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,614.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.31
|
| Rate for Payer: PHCS Commercial |
$4,416.96
|
| Rate for Payer: United Healthcare All Payer |
$4,048.88
|
|
|
WOLVERINE CUT. BALLOON 2.50*6
|
Facility
|
IP
|
$4,601.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.13 |
| Max. Negotiated Rate |
$4,416.96 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.78
|
| Rate for Payer: Cash Price |
$2,300.50
|
| Rate for Payer: Cigna Commercial |
$3,818.83
|
| Rate for Payer: First Health Commercial |
$4,370.95
|
| Rate for Payer: Humana Commercial |
$3,910.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,395.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.31
|
| Rate for Payer: PHCS Commercial |
$4,416.96
|
| Rate for Payer: United Healthcare All Payer |
$4,048.88
|
|
|
WOLVERINE CUT. BALLOON 2.5*10
|
Facility
|
OP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem Medicaid |
$1,532.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Humana KY Medicaid |
$1,532.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 2.5*10
|
Facility
|
IP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 2.5*15
|
Facility
|
OP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem Medicaid |
$1,532.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Humana KY Medicaid |
$1,532.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 2.5*15
|
Facility
|
IP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 2*6
|
Facility
|
IP
|
$4,601.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.13 |
| Max. Negotiated Rate |
$4,416.96 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.78
|
| Rate for Payer: Cash Price |
$2,300.50
|
| Rate for Payer: Cigna Commercial |
$3,818.83
|
| Rate for Payer: First Health Commercial |
$4,370.95
|
| Rate for Payer: Humana Commercial |
$3,910.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,395.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.31
|
| Rate for Payer: PHCS Commercial |
$4,416.96
|
| Rate for Payer: United Healthcare All Payer |
$4,048.88
|
|
|
WOLVERINE CUT. BALLOON 2*6
|
Facility
|
OP
|
$4,601.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.13 |
| Max. Negotiated Rate |
$4,416.96 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Anthem Medicaid |
$1,582.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.78
|
| Rate for Payer: Cash Price |
$2,300.50
|
| Rate for Payer: Cigna Commercial |
$3,818.83
|
| Rate for Payer: First Health Commercial |
$4,370.95
|
| Rate for Payer: Humana Commercial |
$3,910.85
|
| Rate for Payer: Humana KY Medicaid |
$1,582.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,598.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,395.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,614.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.31
|
| Rate for Payer: PHCS Commercial |
$4,416.96
|
| Rate for Payer: United Healthcare All Payer |
$4,048.88
|
|
|
WOLVERINE CUT. BALLOON 3*10
|
Facility
|
OP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem Medicaid |
$1,532.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Humana KY Medicaid |
$1,532.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 3*10
|
Facility
|
IP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 3*15
|
Facility
|
IP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 3*15
|
Facility
|
OP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem Medicaid |
$1,532.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Humana KY Medicaid |
$1,532.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 3.50*6
|
Facility
|
IP
|
$4,601.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.13 |
| Max. Negotiated Rate |
$4,416.96 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.78
|
| Rate for Payer: Cash Price |
$2,300.50
|
| Rate for Payer: Cigna Commercial |
$3,818.83
|
| Rate for Payer: First Health Commercial |
$4,370.95
|
| Rate for Payer: Humana Commercial |
$3,910.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,395.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.31
|
| Rate for Payer: PHCS Commercial |
$4,416.96
|
| Rate for Payer: United Healthcare All Payer |
$4,048.88
|
|
|
WOLVERINE CUT. BALLOON 3.50*6
|
Facility
|
OP
|
$4,601.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.13 |
| Max. Negotiated Rate |
$4,416.96 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Anthem Medicaid |
$1,582.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.78
|
| Rate for Payer: Cash Price |
$2,300.50
|
| Rate for Payer: Cigna Commercial |
$3,818.83
|
| Rate for Payer: First Health Commercial |
$4,370.95
|
| Rate for Payer: Humana Commercial |
$3,910.85
|
| Rate for Payer: Humana KY Medicaid |
$1,582.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,598.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,395.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,614.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.31
|
| Rate for Payer: PHCS Commercial |
$4,416.96
|
| Rate for Payer: United Healthcare All Payer |
$4,048.88
|
|
|
WOLVERINE CUT. BALLOON 3.5*10
|
Facility
|
IP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 3.5*10
|
Facility
|
OP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem Medicaid |
$1,532.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Humana KY Medicaid |
$1,532.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 3.5*15
|
Facility
|
OP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem Medicaid |
$1,532.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Humana KY Medicaid |
$1,532.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 3.5*15
|
Facility
|
IP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 3*6
|
Facility
|
OP
|
$4,601.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.13 |
| Max. Negotiated Rate |
$4,416.96 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Anthem Medicaid |
$1,582.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.78
|
| Rate for Payer: Cash Price |
$2,300.50
|
| Rate for Payer: Cigna Commercial |
$3,818.83
|
| Rate for Payer: First Health Commercial |
$4,370.95
|
| Rate for Payer: Humana Commercial |
$3,910.85
|
| Rate for Payer: Humana KY Medicaid |
$1,582.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,598.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,395.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,614.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.31
|
| Rate for Payer: PHCS Commercial |
$4,416.96
|
| Rate for Payer: United Healthcare All Payer |
$4,048.88
|
|
|
WOLVERINE CUT. BALLOON 3*6
|
Facility
|
IP
|
$4,601.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.13 |
| Max. Negotiated Rate |
$4,416.96 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.78
|
| Rate for Payer: Cash Price |
$2,300.50
|
| Rate for Payer: Cigna Commercial |
$3,818.83
|
| Rate for Payer: First Health Commercial |
$4,370.95
|
| Rate for Payer: Humana Commercial |
$3,910.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,395.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.31
|
| Rate for Payer: PHCS Commercial |
$4,416.96
|
| Rate for Payer: United Healthcare All Payer |
$4,048.88
|
|
|
WOLVERINE CUT. BALLOON 4*10
|
Facility
|
IP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 4*10
|
Facility
|
OP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem Medicaid |
$1,532.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Humana KY Medicaid |
$1,532.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
