|
CATH ANGLED TAPER 5FR*100CM
|
Facility
|
IP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
CATH ANGLED TAPER 5FR*65CM
|
Facility
|
OP
|
$818.48
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem Medicaid |
$281.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Humana KY Medicaid |
$281.48
|
| Rate for Payer: Kentucky WC Medicaid |
$284.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
CATH ANGLED TAPER 5FR*65CM
|
Facility
|
IP
|
$818.48
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
CATH ASCENDA INTRATHECAL 114CM
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CATH ASCENDA INTRATHECAL 114CM
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CATH ASCENDA INTRATHECAL 140CM
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CATH ASCENDA INTRATHECAL 140CM
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CATH ASPIR ST F/PNEUMTHRX 9.0
|
Facility
|
OP
|
$1,525.90
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.37 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,174.94
|
| Rate for Payer: Anthem Medicaid |
$524.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,190.20
|
| Rate for Payer: Cash Price |
$762.95
|
| Rate for Payer: Cigna Commercial |
$1,266.50
|
| Rate for Payer: First Health Commercial |
$1,449.60
|
| Rate for Payer: Humana Commercial |
$1,297.02
|
| Rate for Payer: Humana KY Medicaid |
$524.76
|
| Rate for Payer: Kentucky WC Medicaid |
$530.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,251.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,126.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$535.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,144.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.03
|
| Rate for Payer: PHCS Commercial |
$1,464.86
|
| Rate for Payer: United Healthcare All Payer |
$1,342.79
|
|
|
CATH ASPIR ST F/PNEUMTHRX 9.0
|
Facility
|
IP
|
$1,525.90
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.37 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,174.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,190.20
|
| Rate for Payer: Cash Price |
$762.95
|
| Rate for Payer: Cigna Commercial |
$1,266.50
|
| Rate for Payer: First Health Commercial |
$1,449.60
|
| Rate for Payer: Humana Commercial |
$1,297.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,251.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,126.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,144.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.03
|
| Rate for Payer: PHCS Commercial |
$1,464.86
|
| Rate for Payer: United Healthcare All Payer |
$1,342.79
|
|
|
CATH AVX 50 6FR*50CM
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
CATH AVX 50 6FR*50CM
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
CATH BALLOON BLUE MAX 12*4*75
|
Facility
|
IP
|
$2,029.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.77 |
| Max. Negotiated Rate |
$1,947.84 |
| Rate for Payer: Aetna Commercial |
$1,562.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,582.62
|
| Rate for Payer: Cash Price |
$1,014.50
|
| Rate for Payer: Cigna Commercial |
$1,684.07
|
| Rate for Payer: First Health Commercial |
$1,927.55
|
| Rate for Payer: Humana Commercial |
$1,724.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,663.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,785.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,521.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$628.99
|
| Rate for Payer: PHCS Commercial |
$1,947.84
|
| Rate for Payer: United Healthcare All Payer |
$1,785.52
|
|
|
CATH BALLOON BLUE MAX 12*4*75
|
Facility
|
OP
|
$2,029.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.77 |
| Max. Negotiated Rate |
$1,947.84 |
| Rate for Payer: Aetna Commercial |
$1,562.33
|
| Rate for Payer: Anthem Medicaid |
$697.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,582.62
|
| Rate for Payer: Cash Price |
$1,014.50
|
| Rate for Payer: Cigna Commercial |
$1,684.07
|
| Rate for Payer: First Health Commercial |
$1,927.55
|
| Rate for Payer: Humana Commercial |
$1,724.65
|
| Rate for Payer: Humana KY Medicaid |
$697.77
|
| Rate for Payer: Kentucky WC Medicaid |
$704.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,663.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$711.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,785.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,521.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$628.99
|
| Rate for Payer: PHCS Commercial |
$1,947.84
|
| Rate for Payer: United Healthcare All Payer |
$1,785.52
|
|
|
CATH BALLOON BLUE MAX 5*4*40
|
Facility
|
IP
|
$2,029.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.77 |
| Max. Negotiated Rate |
$1,947.84 |
| Rate for Payer: Aetna Commercial |
$1,562.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,582.62
|
| Rate for Payer: Cash Price |
$1,014.50
|
| Rate for Payer: Cigna Commercial |
$1,684.07
|
| Rate for Payer: First Health Commercial |
$1,927.55
|
| Rate for Payer: Humana Commercial |
$1,724.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,663.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,785.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,521.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$628.99
|
| Rate for Payer: PHCS Commercial |
$1,947.84
|
| Rate for Payer: United Healthcare All Payer |
$1,785.52
|
|
|
CATH BALLOON BLUE MAX 5*4*40
|
Facility
|
OP
|
$2,029.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.77 |
| Max. Negotiated Rate |
$1,947.84 |
| Rate for Payer: Aetna Commercial |
$1,562.33
|
| Rate for Payer: Anthem Medicaid |
$697.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,582.62
|
| Rate for Payer: Cash Price |
$1,014.50
|
| Rate for Payer: Cigna Commercial |
$1,684.07
|
| Rate for Payer: First Health Commercial |
$1,927.55
|
| Rate for Payer: Humana Commercial |
$1,724.65
|
| Rate for Payer: Humana KY Medicaid |
$697.77
|
| Rate for Payer: Kentucky WC Medicaid |
$704.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,663.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$711.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,785.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,521.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$628.99
|
| Rate for Payer: PHCS Commercial |
$1,947.84
|
| Rate for Payer: United Healthcare All Payer |
$1,785.52
|
|
|
CATH BALLOON BLUE MAX 6*4*75
|
Facility
|
IP
|
$2,202.11
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.27 |
| Max. Negotiated Rate |
$2,114.03 |
| Rate for Payer: Aetna Commercial |
$1,695.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,717.65
|
| Rate for Payer: Cash Price |
$1,101.06
|
| Rate for Payer: Cigna Commercial |
$1,827.75
|
| Rate for Payer: First Health Commercial |
$2,092.00
|
| Rate for Payer: Humana Commercial |
$1,871.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,805.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,625.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,937.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,651.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.65
|
| Rate for Payer: PHCS Commercial |
$2,114.03
|
| Rate for Payer: United Healthcare All Payer |
$1,937.86
|
|
|
CATH BALLOON BLUE MAX 6*4*75
|
Facility
|
OP
|
$2,202.11
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.27 |
| Max. Negotiated Rate |
$2,114.03 |
| Rate for Payer: Aetna Commercial |
$1,695.62
|
| Rate for Payer: Anthem Medicaid |
$757.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,717.65
|
| Rate for Payer: Cash Price |
$1,101.06
|
| Rate for Payer: Cigna Commercial |
$1,827.75
|
| Rate for Payer: First Health Commercial |
$2,092.00
|
| Rate for Payer: Humana Commercial |
$1,871.79
|
| Rate for Payer: Humana KY Medicaid |
$757.31
|
| Rate for Payer: Kentucky WC Medicaid |
$765.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,805.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,625.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$772.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,937.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,651.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.65
|
| Rate for Payer: PHCS Commercial |
$2,114.03
|
| Rate for Payer: United Healthcare All Payer |
$1,937.86
|
|
|
CATH BALLOON DILATOR 15FR*4CM
|
Facility
|
IP
|
$3,379.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.34 |
| Max. Negotiated Rate |
$3,244.32 |
| Rate for Payer: Aetna Commercial |
$2,602.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,636.01
|
| Rate for Payer: Cash Price |
$1,689.75
|
| Rate for Payer: Cigna Commercial |
$2,804.98
|
| Rate for Payer: First Health Commercial |
$3,210.52
|
| Rate for Payer: Humana Commercial |
$2,872.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,771.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,494.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,973.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,534.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,047.64
|
| Rate for Payer: PHCS Commercial |
$3,244.32
|
| Rate for Payer: United Healthcare All Payer |
$2,973.96
|
|
|
CATH BALLOON DILATOR 15FR*4CM
|
Facility
|
OP
|
$3,379.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.34 |
| Max. Negotiated Rate |
$3,244.32 |
| Rate for Payer: Aetna Commercial |
$2,602.22
|
| Rate for Payer: Anthem Medicaid |
$1,162.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,636.01
|
| Rate for Payer: Cash Price |
$1,689.75
|
| Rate for Payer: Cigna Commercial |
$2,804.98
|
| Rate for Payer: First Health Commercial |
$3,210.52
|
| Rate for Payer: Humana Commercial |
$2,872.58
|
| Rate for Payer: Humana KY Medicaid |
$1,162.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,174.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,771.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,494.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,185.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,973.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,534.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,047.64
|
| Rate for Payer: PHCS Commercial |
$3,244.32
|
| Rate for Payer: United Healthcare All Payer |
$2,973.96
|
|
|
CATH BALLOON DILATOR 21FR*4CM
|
Facility
|
IP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
CATH BALLOON DILATOR 21FR*4CM
|
Facility
|
OP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem Medicaid |
$662.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Humana KY Medicaid |
$662.87
|
| Rate for Payer: Kentucky WC Medicaid |
$669.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$676.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
CATH BALLOON DILATOR 5*10
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
CATH BALLOON DILATOR 5*10
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem Medicaid |
$632.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Humana KY Medicaid |
$632.78
|
| Rate for Payer: Kentucky WC Medicaid |
$639.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
CATH BALLOON DILATOR 6*10
|
Facility
|
OP
|
$3,267.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.78 |
| Max. Negotiated Rate |
$3,136.80 |
| Rate for Payer: Aetna Commercial |
$2,515.98
|
| Rate for Payer: Anthem Medicaid |
$1,123.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,548.65
|
| Rate for Payer: Cash Price |
$1,633.75
|
| Rate for Payer: Cigna Commercial |
$2,712.02
|
| Rate for Payer: First Health Commercial |
$3,104.12
|
| Rate for Payer: Humana Commercial |
$2,777.38
|
| Rate for Payer: Humana KY Medicaid |
$1,123.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,135.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,679.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,411.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$980.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,146.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,875.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,450.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$653.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,012.92
|
| Rate for Payer: PHCS Commercial |
$3,136.80
|
| Rate for Payer: United Healthcare All Payer |
$2,875.40
|
|
|
CATH BALLOON DILATOR 6*10
|
Facility
|
IP
|
$3,267.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.78 |
| Max. Negotiated Rate |
$3,136.80 |
| Rate for Payer: Aetna Commercial |
$2,515.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,548.65
|
| Rate for Payer: Cash Price |
$1,633.75
|
| Rate for Payer: Cigna Commercial |
$2,712.02
|
| Rate for Payer: First Health Commercial |
$3,104.12
|
| Rate for Payer: Humana Commercial |
$2,777.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,679.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,411.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$980.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,875.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,450.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$653.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,012.92
|
| Rate for Payer: PHCS Commercial |
$3,136.80
|
| Rate for Payer: United Healthcare All Payer |
$2,875.40
|
|
