|
CATH ASPIR ST F/PNEUMTHRX 9.0
|
Facility
|
OP
|
$1,499.55
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.87 |
| Max. Negotiated Rate |
$1,439.57 |
| Rate for Payer: Aetna Commercial |
$1,154.65
|
| Rate for Payer: Anthem Medicaid |
$515.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,169.65
|
| Rate for Payer: Cash Price |
$749.78
|
| Rate for Payer: Cigna Commercial |
$1,244.63
|
| Rate for Payer: First Health Commercial |
$1,424.57
|
| Rate for Payer: Humana Commercial |
$1,274.62
|
| Rate for Payer: Humana KY Medicaid |
$515.70
|
| Rate for Payer: Kentucky WC Medicaid |
$520.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,229.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,106.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$449.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,319.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,124.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,199.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.69
|
| Rate for Payer: PHCS Commercial |
$1,439.57
|
| Rate for Payer: United Healthcare All Payer |
$1,319.60
|
|
|
CATH ASPIR ST F/PNEUMTHRX 9.0
|
Facility
|
IP
|
$1,499.55
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.87 |
| Max. Negotiated Rate |
$1,439.57 |
| Rate for Payer: Aetna Commercial |
$1,154.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,169.65
|
| Rate for Payer: Cash Price |
$749.78
|
| Rate for Payer: Cigna Commercial |
$1,244.63
|
| Rate for Payer: First Health Commercial |
$1,424.57
|
| Rate for Payer: Humana Commercial |
$1,274.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,229.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,106.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$449.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,319.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,124.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,199.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.69
|
| Rate for Payer: PHCS Commercial |
$1,439.57
|
| Rate for Payer: United Healthcare All Payer |
$1,319.60
|
|
|
CATH AVX 50 6FR*50CM
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
CATH AVX 50 6FR*50CM
|
Facility
|
OP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
CATH BALLOON BLUE MAX 12*4*75
|
Facility
|
IP
|
$2,037.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.16 |
| Max. Negotiated Rate |
$1,955.71 |
| Rate for Payer: Aetna Commercial |
$1,568.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.02
|
| Rate for Payer: Cash Price |
$1,018.60
|
| Rate for Payer: Cigna Commercial |
$1,690.88
|
| Rate for Payer: First Health Commercial |
$1,935.34
|
| Rate for Payer: Humana Commercial |
$1,731.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.67
|
| Rate for Payer: PHCS Commercial |
$1,955.71
|
| Rate for Payer: United Healthcare All Payer |
$1,792.74
|
|
|
CATH BALLOON BLUE MAX 12*4*75
|
Facility
|
OP
|
$2,037.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.16 |
| Max. Negotiated Rate |
$1,955.71 |
| Rate for Payer: Aetna Commercial |
$1,568.64
|
| Rate for Payer: Anthem Medicaid |
$700.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.02
|
| Rate for Payer: Cash Price |
$1,018.60
|
| Rate for Payer: Cigna Commercial |
$1,690.88
|
| Rate for Payer: First Health Commercial |
$1,935.34
|
| Rate for Payer: Humana Commercial |
$1,731.62
|
| Rate for Payer: Humana KY Medicaid |
$700.59
|
| Rate for Payer: Kentucky WC Medicaid |
$707.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$714.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.67
|
| Rate for Payer: PHCS Commercial |
$1,955.71
|
| Rate for Payer: United Healthcare All Payer |
$1,792.74
|
|
|
CATH BALLOON BLUE MAX 5*4*40
|
Facility
|
OP
|
$2,037.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.16 |
| Max. Negotiated Rate |
$1,955.71 |
| Rate for Payer: Aetna Commercial |
$1,568.64
|
| Rate for Payer: Anthem Medicaid |
$700.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.02
|
| Rate for Payer: Cash Price |
$1,018.60
|
| Rate for Payer: Cigna Commercial |
$1,690.88
|
| Rate for Payer: First Health Commercial |
$1,935.34
|
| Rate for Payer: Humana Commercial |
$1,731.62
|
| Rate for Payer: Humana KY Medicaid |
$700.59
|
| Rate for Payer: Kentucky WC Medicaid |
$707.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$714.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.67
|
| Rate for Payer: PHCS Commercial |
$1,955.71
|
| Rate for Payer: United Healthcare All Payer |
$1,792.74
|
|
|
CATH BALLOON BLUE MAX 5*4*40
|
Facility
|
IP
|
$2,037.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.16 |
| Max. Negotiated Rate |
$1,955.71 |
| Rate for Payer: Aetna Commercial |
$1,568.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.02
|
| Rate for Payer: Cash Price |
$1,018.60
|
| Rate for Payer: Cigna Commercial |
$1,690.88
|
| Rate for Payer: First Health Commercial |
$1,935.34
|
| Rate for Payer: Humana Commercial |
$1,731.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.67
|
| Rate for Payer: PHCS Commercial |
$1,955.71
|
| Rate for Payer: United Healthcare All Payer |
$1,792.74
|
|
|
CATH BALLOON BLUE MAX 6*4*75
|
Facility
|
OP
|
$2,225.15
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$667.54 |
| Max. Negotiated Rate |
$2,136.14 |
| Rate for Payer: Aetna Commercial |
$1,713.37
|
| Rate for Payer: Anthem Medicaid |
$765.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,735.62
|
| Rate for Payer: Cash Price |
$1,112.57
|
| Rate for Payer: Cigna Commercial |
$1,846.87
|
| Rate for Payer: First Health Commercial |
$2,113.89
|
| Rate for Payer: Humana Commercial |
$1,891.38
|
| Rate for Payer: Humana KY Medicaid |
$765.23
|
| Rate for Payer: Kentucky WC Medicaid |
$773.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,824.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,642.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$780.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,958.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,668.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,935.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,535.35
|
| Rate for Payer: PHCS Commercial |
$2,136.14
|
| Rate for Payer: United Healthcare All Payer |
$1,958.13
|
|
|
CATH BALLOON BLUE MAX 6*4*75
|
Facility
|
IP
|
$2,225.15
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$667.54 |
| Max. Negotiated Rate |
$2,136.14 |
| Rate for Payer: Aetna Commercial |
$1,713.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,735.62
|
| Rate for Payer: Cash Price |
$1,112.57
|
| Rate for Payer: Cigna Commercial |
$1,846.87
|
| Rate for Payer: First Health Commercial |
$2,113.89
|
| Rate for Payer: Humana Commercial |
$1,891.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,824.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,642.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,958.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,668.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,935.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,535.35
|
| Rate for Payer: PHCS Commercial |
$2,136.14
|
| Rate for Payer: United Healthcare All Payer |
$1,958.13
|
|
|
CATH BALLOON DILATOR 15FR*4CM
|
Facility
|
IP
|
$3,263.75
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$979.12 |
| Max. Negotiated Rate |
$3,133.20 |
| Rate for Payer: Aetna Commercial |
$2,513.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.72
|
| Rate for Payer: Cash Price |
$1,631.88
|
| Rate for Payer: Cigna Commercial |
$2,708.91
|
| Rate for Payer: First Health Commercial |
$3,100.56
|
| Rate for Payer: Humana Commercial |
$2,774.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,447.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,611.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,839.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,251.99
|
| Rate for Payer: PHCS Commercial |
$3,133.20
|
| Rate for Payer: United Healthcare All Payer |
$2,872.10
|
|
|
CATH BALLOON DILATOR 15FR*4CM
|
Facility
|
OP
|
$3,263.75
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$979.12 |
| Max. Negotiated Rate |
$3,133.20 |
| Rate for Payer: Aetna Commercial |
$2,513.09
|
| Rate for Payer: Anthem Medicaid |
$1,122.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.72
|
| Rate for Payer: Cash Price |
$1,631.88
|
| Rate for Payer: Cigna Commercial |
$2,708.91
|
| Rate for Payer: First Health Commercial |
$3,100.56
|
| Rate for Payer: Humana Commercial |
$2,774.19
|
| Rate for Payer: Humana KY Medicaid |
$1,122.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,133.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,144.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,447.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,611.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,839.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,251.99
|
| Rate for Payer: PHCS Commercial |
$3,133.20
|
| Rate for Payer: United Healthcare All Payer |
$2,872.10
|
|
|
CATH BALLOON DILATOR 21FR*4CM
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.10 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna Commercial |
$1,483.79
|
| Rate for Payer: Anthem Medicaid |
$662.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,599.41
|
| Rate for Payer: First Health Commercial |
$1,830.65
|
| Rate for Payer: Humana Commercial |
$1,637.95
|
| Rate for Payer: Humana KY Medicaid |
$662.70
|
| Rate for Payer: Kentucky WC Medicaid |
$669.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,676.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.63
|
| Rate for Payer: PHCS Commercial |
$1,849.92
|
| Rate for Payer: United Healthcare All Payer |
$1,695.76
|
|
|
CATH BALLOON DILATOR 21FR*4CM
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.10 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna Commercial |
$1,483.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,599.41
|
| Rate for Payer: First Health Commercial |
$1,830.65
|
| Rate for Payer: Humana Commercial |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,676.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.63
|
| Rate for Payer: PHCS Commercial |
$1,849.92
|
| Rate for Payer: United Healthcare All Payer |
$1,695.76
|
|
|
CATH BALLOON DILATOR 5*10
|
Facility
|
OP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem Medicaid |
$630.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Humana KY Medicaid |
$630.02
|
| Rate for Payer: Kentucky WC Medicaid |
$636.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
|
CATH BALLOON DILATOR 5*10
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
|
CATH BALLOON DILATOR 6*10
|
Facility
|
OP
|
$3,143.75
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$943.12 |
| Max. Negotiated Rate |
$3,018.00 |
| Rate for Payer: Aetna Commercial |
$2,420.69
|
| Rate for Payer: Anthem Medicaid |
$1,081.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,452.12
|
| Rate for Payer: Cash Price |
$1,571.88
|
| Rate for Payer: Cigna Commercial |
$2,609.31
|
| Rate for Payer: First Health Commercial |
$2,986.56
|
| Rate for Payer: Humana Commercial |
$2,672.19
|
| Rate for Payer: Humana KY Medicaid |
$1,081.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,092.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,577.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,320.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$943.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,102.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,766.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,357.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,515.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,735.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.19
|
| Rate for Payer: PHCS Commercial |
$3,018.00
|
| Rate for Payer: United Healthcare All Payer |
$2,766.50
|
|
|
CATH BALLOON DILATOR 6*10
|
Facility
|
IP
|
$3,143.75
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$943.12 |
| Max. Negotiated Rate |
$3,018.00 |
| Rate for Payer: Aetna Commercial |
$2,420.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,452.12
|
| Rate for Payer: Cash Price |
$1,571.88
|
| Rate for Payer: Cigna Commercial |
$2,609.31
|
| Rate for Payer: First Health Commercial |
$2,986.56
|
| Rate for Payer: Humana Commercial |
$2,672.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,577.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,320.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$943.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,766.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,357.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,515.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,735.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.19
|
| Rate for Payer: PHCS Commercial |
$3,018.00
|
| Rate for Payer: United Healthcare All Payer |
$2,766.50
|
|
|
CATH BALLOON MARSHALL 5MM*2CM
|
Facility
|
IP
|
$2,210.86
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.26 |
| Max. Negotiated Rate |
$2,122.43 |
| Rate for Payer: Aetna Commercial |
$1,702.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.47
|
| Rate for Payer: Cash Price |
$1,105.43
|
| Rate for Payer: Cigna Commercial |
$1,835.01
|
| Rate for Payer: First Health Commercial |
$2,100.32
|
| Rate for Payer: Humana Commercial |
$1,879.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,812.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,923.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,525.49
|
| Rate for Payer: PHCS Commercial |
$2,122.43
|
| Rate for Payer: United Healthcare All Payer |
$1,945.56
|
|
|
CATH BALLOON MARSHALL 5MM*2CM
|
Facility
|
OP
|
$2,210.86
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.26 |
| Max. Negotiated Rate |
$2,122.43 |
| Rate for Payer: Aetna Commercial |
$1,702.36
|
| Rate for Payer: Anthem Medicaid |
$760.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.47
|
| Rate for Payer: Cash Price |
$1,105.43
|
| Rate for Payer: Cigna Commercial |
$1,835.01
|
| Rate for Payer: First Health Commercial |
$2,100.32
|
| Rate for Payer: Humana Commercial |
$1,879.23
|
| Rate for Payer: Humana KY Medicaid |
$760.31
|
| Rate for Payer: Kentucky WC Medicaid |
$768.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,812.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$775.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,923.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,525.49
|
| Rate for Payer: PHCS Commercial |
$2,122.43
|
| Rate for Payer: United Healthcare All Payer |
$1,945.56
|
|
|
CATH BALLOON MARSHALL 7MM*2CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CATH BALLOON MARSHALL 7MM*2CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CATH BALLOON ULTRA THIN 4*4*90
|
Facility
|
OP
|
$2,101.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.54 |
| Max. Negotiated Rate |
$2,017.73 |
| Rate for Payer: Aetna Commercial |
$1,618.39
|
| Rate for Payer: Anthem Medicaid |
$722.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.40
|
| Rate for Payer: Cash Price |
$1,050.90
|
| Rate for Payer: Cigna Commercial |
$1,744.49
|
| Rate for Payer: First Health Commercial |
$1,996.71
|
| Rate for Payer: Humana Commercial |
$1,786.53
|
| Rate for Payer: Humana KY Medicaid |
$722.81
|
| Rate for Payer: Kentucky WC Medicaid |
$730.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,723.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,849.58
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,681.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,828.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.24
|
| Rate for Payer: PHCS Commercial |
$2,017.73
|
| Rate for Payer: United Healthcare All Payer |
$1,849.58
|
|
|
CATH BALLOON ULTRA THIN 4*4*90
|
Facility
|
IP
|
$2,101.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.54 |
| Max. Negotiated Rate |
$2,017.73 |
| Rate for Payer: Aetna Commercial |
$1,618.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.40
|
| Rate for Payer: Cash Price |
$1,050.90
|
| Rate for Payer: Cigna Commercial |
$1,744.49
|
| Rate for Payer: First Health Commercial |
$1,996.71
|
| Rate for Payer: Humana Commercial |
$1,786.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,723.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,849.58
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,681.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,828.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.24
|
| Rate for Payer: PHCS Commercial |
$2,017.73
|
| Rate for Payer: United Healthcare All Payer |
$1,849.58
|
|
|
CATH BALLOON ULTRA THIN 5*2*90
|
Facility
|
OP
|
$2,101.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.54 |
| Max. Negotiated Rate |
$2,017.73 |
| Rate for Payer: Aetna Commercial |
$1,618.39
|
| Rate for Payer: Anthem Medicaid |
$722.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.40
|
| Rate for Payer: Cash Price |
$1,050.90
|
| Rate for Payer: Cigna Commercial |
$1,744.49
|
| Rate for Payer: First Health Commercial |
$1,996.71
|
| Rate for Payer: Humana Commercial |
$1,786.53
|
| Rate for Payer: Humana KY Medicaid |
$722.81
|
| Rate for Payer: Kentucky WC Medicaid |
$730.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,723.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,849.58
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,681.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,828.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.24
|
| Rate for Payer: PHCS Commercial |
$2,017.73
|
| Rate for Payer: United Healthcare All Payer |
$1,849.58
|
|
