|
CATH BALLOON ULTRA THIN 8*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 9*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 9*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: 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
|
| Rate for Payer: Aetna Commercial |
$1,608.14
|
|
|
CATH BALLOON ULTRA THIN 9*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 9*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 UROMAX 18FR
|
Facility
|
OP
|
$3,148.78
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.34 |
| Max. Negotiated Rate |
$3,022.83 |
| Rate for Payer: Aetna Commercial |
$2,424.56
|
| Rate for Payer: Anthem Medicaid |
$1,082.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,456.05
|
| Rate for Payer: Cash Price |
$1,574.39
|
| Rate for Payer: Cigna Commercial |
$2,613.49
|
| Rate for Payer: First Health Commercial |
$2,991.34
|
| Rate for Payer: Humana Commercial |
$2,676.46
|
| Rate for Payer: Humana KY Medicaid |
$1,082.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,323.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,104.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,770.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,361.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$976.12
|
| Rate for Payer: PHCS Commercial |
$3,022.83
|
| Rate for Payer: United Healthcare All Payer |
$2,770.93
|
|
|
CATH BALLOON UROMAX 18FR
|
Facility
|
IP
|
$3,148.78
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.34 |
| Max. Negotiated Rate |
$3,022.83 |
| Rate for Payer: Aetna Commercial |
$2,424.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,456.05
|
| Rate for Payer: Cash Price |
$1,574.39
|
| Rate for Payer: Cigna Commercial |
$2,613.49
|
| Rate for Payer: First Health Commercial |
$2,991.34
|
| Rate for Payer: Humana Commercial |
$2,676.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,323.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,770.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,361.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$976.12
|
| Rate for Payer: PHCS Commercial |
$3,022.83
|
| Rate for Payer: United Healthcare All Payer |
$2,770.93
|
|
|
CATH BALLOON XXL*12*2*5.8*75
|
Facility
|
OP
|
$3,216.61
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.16 |
| Max. Negotiated Rate |
$3,087.95 |
| Rate for Payer: Aetna Commercial |
$2,476.79
|
| Rate for Payer: Anthem Medicaid |
$1,106.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,508.96
|
| Rate for Payer: Cash Price |
$1,608.31
|
| Rate for Payer: Cigna Commercial |
$2,669.79
|
| Rate for Payer: First Health Commercial |
$3,055.78
|
| Rate for Payer: Humana Commercial |
$2,734.12
|
| Rate for Payer: Humana KY Medicaid |
$1,106.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,117.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,637.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,373.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,830.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,412.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.15
|
| Rate for Payer: PHCS Commercial |
$3,087.95
|
| Rate for Payer: United Healthcare All Payer |
$2,830.62
|
|
|
CATH BALLOON XXL*12*2*5.8*75
|
Facility
|
IP
|
$3,216.61
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.16 |
| Max. Negotiated Rate |
$3,087.95 |
| Rate for Payer: Aetna Commercial |
$2,476.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,508.96
|
| Rate for Payer: Cash Price |
$1,608.31
|
| Rate for Payer: Cigna Commercial |
$2,669.79
|
| Rate for Payer: First Health Commercial |
$3,055.78
|
| Rate for Payer: Humana Commercial |
$2,734.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,637.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,373.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,830.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,412.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.15
|
| Rate for Payer: PHCS Commercial |
$3,087.95
|
| Rate for Payer: United Healthcare All Payer |
$2,830.62
|
|
|
CATH BALLOON XXL 12*4
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
CATH BALLOON XXL 12*4
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
CATH BALLOON XXL*14*2*5.8*75
|
Facility
|
IP
|
$3,216.61
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.16 |
| Max. Negotiated Rate |
$3,087.95 |
| Rate for Payer: Aetna Commercial |
$2,476.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,508.96
|
| Rate for Payer: Cash Price |
$1,608.31
|
| Rate for Payer: Cigna Commercial |
$2,669.79
|
| Rate for Payer: First Health Commercial |
$3,055.78
|
| Rate for Payer: Humana Commercial |
$2,734.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,637.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,373.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,830.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,412.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.15
|
| Rate for Payer: PHCS Commercial |
$3,087.95
|
| Rate for Payer: United Healthcare All Payer |
$2,830.62
|
|
|
CATH BALLOON XXL*14*2*5.8*75
|
Facility
|
OP
|
$3,216.61
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.16 |
| Max. Negotiated Rate |
$3,087.95 |
| Rate for Payer: Aetna Commercial |
$2,476.79
|
| Rate for Payer: Anthem Medicaid |
$1,106.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,508.96
|
| Rate for Payer: Cash Price |
$1,608.31
|
| Rate for Payer: Cigna Commercial |
$2,669.79
|
| Rate for Payer: First Health Commercial |
$3,055.78
|
| Rate for Payer: Humana Commercial |
$2,734.12
|
| Rate for Payer: Humana KY Medicaid |
$1,106.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,117.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,637.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,373.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,830.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,412.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.15
|
| Rate for Payer: PHCS Commercial |
$3,087.95
|
| Rate for Payer: United Healthcare All Payer |
$2,830.62
|
|
|
CATH BALLOON XXL*18*2*5.8*75
|
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 XXL*18*2*5.8*75
|
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 BALOON ULTRA THIN 10*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: 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
|
| 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
|
|
|
CATH BALOON ULTRA THIN 10*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 BALOON ULTRA THIN 10*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 BALOON ULTRA THIN 10*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 BALOON ULTRA THIN 4*2*90
|
Facility
|
OP
|
$2,018.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.40 |
| Max. Negotiated Rate |
$1,937.76 |
| Rate for Payer: Aetna Commercial |
$1,554.24
|
| Rate for Payer: Anthem Medicaid |
$694.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.43
|
| Rate for Payer: Cash Price |
$1,009.25
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: First Health Commercial |
$1,917.58
|
| Rate for Payer: Humana Commercial |
$1,715.72
|
| Rate for Payer: Humana KY Medicaid |
$694.16
|
| Rate for Payer: Kentucky WC Medicaid |
$701.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,489.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$708.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,513.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.74
|
| Rate for Payer: PHCS Commercial |
$1,937.76
|
| Rate for Payer: United Healthcare All Payer |
$1,776.28
|
|
|
CATH BALOON ULTRA THIN 4*2*90
|
Facility
|
IP
|
$2,018.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.40 |
| Max. Negotiated Rate |
$1,937.76 |
| Rate for Payer: Aetna Commercial |
$1,554.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.43
|
| Rate for Payer: Cash Price |
$1,009.25
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: First Health Commercial |
$1,917.58
|
| Rate for Payer: Humana Commercial |
$1,715.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,489.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,513.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.74
|
| Rate for Payer: PHCS Commercial |
$1,937.76
|
| Rate for Payer: United Healthcare All Payer |
$1,776.28
|
|
|
CATH BALOON ULTRA THIN 6*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 BALOON ULTRA THIN 6*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 BARRX ENDO TTS-1100
|
Facility
|
OP
|
$9,567.10
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,243.72 |
| Max. Negotiated Rate |
$9,184.42 |
| Rate for Payer: Aetna Commercial |
$7,366.67
|
| Rate for Payer: Anthem Medicaid |
$3,290.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,462.34
|
| Rate for Payer: Cash Price |
$4,783.55
|
| Rate for Payer: Cigna Commercial |
$7,940.69
|
| Rate for Payer: First Health Commercial |
$9,088.74
|
| Rate for Payer: Humana Commercial |
$8,132.04
|
| Rate for Payer: Humana KY Medicaid |
$3,290.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,323.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,845.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,060.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,870.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,356.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,419.05
|
| Rate for Payer: Ohio Health Group HMO |
$7,175.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,913.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,243.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,965.80
|
| Rate for Payer: PHCS Commercial |
$9,184.42
|
| Rate for Payer: United Healthcare All Payer |
$8,419.05
|
|
|
CATH BARRX ENDO TTS-1100
|
Facility
|
IP
|
$9,567.10
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,243.72 |
| Max. Negotiated Rate |
$9,184.42 |
| Rate for Payer: Aetna Commercial |
$7,366.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,462.34
|
| Rate for Payer: Cash Price |
$4,783.55
|
| Rate for Payer: Cigna Commercial |
$7,940.69
|
| Rate for Payer: First Health Commercial |
$9,088.74
|
| Rate for Payer: Humana Commercial |
$8,132.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,845.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,060.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,870.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,419.05
|
| Rate for Payer: Ohio Health Group HMO |
$7,175.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,913.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,243.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,965.80
|
| Rate for Payer: PHCS Commercial |
$9,184.42
|
| Rate for Payer: United Healthcare All Payer |
$8,419.05
|
|
