|
CATH BALLOON MARSHALL 5MM*2CM
|
Facility
|
OP
|
$2,188.95
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.56 |
| Max. Negotiated Rate |
$2,101.39 |
| Rate for Payer: Aetna Commercial |
$1,685.49
|
| Rate for Payer: Anthem Medicaid |
$752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,707.38
|
| Rate for Payer: Cash Price |
$1,094.47
|
| Rate for Payer: Cigna Commercial |
$1,816.83
|
| Rate for Payer: First Health Commercial |
$2,079.50
|
| Rate for Payer: Humana Commercial |
$1,860.61
|
| Rate for Payer: Humana KY Medicaid |
$752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$760.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,794.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,615.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$767.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,926.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,641.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.57
|
| Rate for Payer: PHCS Commercial |
$2,101.39
|
| Rate for Payer: United Healthcare All Payer |
$1,926.28
|
|
|
CATH BALLOON MARSHALL 5MM*2CM
|
Facility
|
IP
|
$2,188.95
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.56 |
| Max. Negotiated Rate |
$2,101.39 |
| Rate for Payer: Humana Commercial |
$1,860.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,794.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,615.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,926.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,641.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.57
|
| Rate for Payer: PHCS Commercial |
$2,101.39
|
| Rate for Payer: United Healthcare All Payer |
$1,926.28
|
| Rate for Payer: Aetna Commercial |
$1,685.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,707.38
|
| Rate for Payer: Cash Price |
$1,094.47
|
| Rate for Payer: Cigna Commercial |
$1,816.83
|
| Rate for Payer: First Health Commercial |
$2,079.50
|
|
|
CATH BALLOON MARSHALL 7MM*2CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CATH BALLOON MARSHALL 7MM*2CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CATH BALLOON ULTRA THIN 4*4*90
|
Facility
|
IP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 4*4*90
|
Facility
|
OP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem Medicaid |
$718.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Humana KY Medicaid |
$718.24
|
| Rate for Payer: Kentucky WC Medicaid |
$725.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 5*2*90
|
Facility
|
OP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem Medicaid |
$718.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Humana KY Medicaid |
$718.24
|
| Rate for Payer: Kentucky WC Medicaid |
$725.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 5*2*90
|
Facility
|
IP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 5*4*50
|
Facility
|
OP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Humana KY Medicaid |
$718.24
|
| Rate for Payer: Kentucky WC Medicaid |
$725.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem Medicaid |
$718.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
|
|
CATH BALLOON ULTRA THIN 5*4*50
|
Facility
|
IP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 5*4*90
|
Facility
|
OP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem Medicaid |
$718.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Humana KY Medicaid |
$718.24
|
| Rate for Payer: Kentucky WC Medicaid |
$725.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 5*4*90
|
Facility
|
IP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 6*2*75
|
Facility
|
OP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem Medicaid |
$718.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Humana KY Medicaid |
$718.24
|
| Rate for Payer: Kentucky WC Medicaid |
$725.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 6*2*75
|
Facility
|
IP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 6*4*75
|
Facility
|
IP
|
$2,188.95
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.56 |
| Max. Negotiated Rate |
$2,101.39 |
| Rate for Payer: Aetna Commercial |
$1,685.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,707.38
|
| Rate for Payer: Cash Price |
$1,094.47
|
| Rate for Payer: Cigna Commercial |
$1,816.83
|
| Rate for Payer: First Health Commercial |
$2,079.50
|
| Rate for Payer: Humana Commercial |
$1,860.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,794.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,615.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,926.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,641.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.57
|
| Rate for Payer: PHCS Commercial |
$2,101.39
|
| Rate for Payer: United Healthcare All Payer |
$1,926.28
|
|
|
CATH BALLOON ULTRA THIN 6*4*75
|
Facility
|
OP
|
$2,188.95
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.56 |
| Max. Negotiated Rate |
$2,101.39 |
| Rate for Payer: Aetna Commercial |
$1,685.49
|
| Rate for Payer: Anthem Medicaid |
$752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,707.38
|
| Rate for Payer: Cash Price |
$1,094.47
|
| Rate for Payer: Cigna Commercial |
$1,816.83
|
| Rate for Payer: First Health Commercial |
$2,079.50
|
| Rate for Payer: Humana Commercial |
$1,860.61
|
| Rate for Payer: Humana KY Medicaid |
$752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$760.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,794.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,615.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$767.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,926.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,641.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.57
|
| Rate for Payer: PHCS Commercial |
$2,101.39
|
| Rate for Payer: United Healthcare All Payer |
$1,926.28
|
|
|
CATH BALLOON ULTRA THIN 6*4*90
|
Facility
|
IP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 6*4*90
|
Facility
|
OP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem Medicaid |
$718.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Humana KY Medicaid |
$718.24
|
| Rate for Payer: Kentucky WC Medicaid |
$725.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 7*2*90
|
Facility
|
IP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 7*2*90
|
Facility
|
OP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem Medicaid |
$718.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Humana KY Medicaid |
$718.24
|
| Rate for Payer: Kentucky WC Medicaid |
$725.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 7*4*90
|
Facility
|
OP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem Medicaid |
$718.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Humana KY Medicaid |
$718.24
|
| Rate for Payer: Kentucky WC Medicaid |
$725.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 7*4*90
|
Facility
|
IP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 8*2*90
|
Facility
|
IP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 8*2*90
|
Facility
|
OP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem Medicaid |
$718.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Humana KY Medicaid |
$718.24
|
| Rate for Payer: Kentucky WC Medicaid |
$725.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
CATH BALLOON ULTRA THIN 8*4*90
|
Facility
|
OP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem Medicaid |
$718.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.46
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Humana KY Medicaid |
$718.24
|
| Rate for Payer: Kentucky WC Medicaid |
$725.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.44
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
