|
CATH BALLOON ULTRA THIN 5*2*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*4*50
|
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 5*4*50
|
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*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*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 6*2*75
|
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 6*2*75
|
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 6*4*75
|
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 ULTRA THIN 6*4*75
|
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 ULTRA THIN 6*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 6*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 7*2*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 7*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
|
|
|
CATH BALLOON ULTRA THIN 7*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 7*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 8*2*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 8*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
|
|
|
CATH BALLOON ULTRA THIN 8*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 8*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 9*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
|
|
|
CATH BALLOON ULTRA THIN 9*2*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 9*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 9*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 UROMAX 18FR
|
Facility
|
IP
|
$3,016.55
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$904.97 |
| Max. Negotiated Rate |
$2,895.89 |
| Rate for Payer: Aetna Commercial |
$2,322.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,352.91
|
| Rate for Payer: Cash Price |
$1,508.28
|
| Rate for Payer: Cigna Commercial |
$2,503.74
|
| Rate for Payer: First Health Commercial |
$2,865.72
|
| Rate for Payer: Humana Commercial |
$2,564.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,473.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,226.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$904.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,654.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,262.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,413.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,624.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,081.42
|
| Rate for Payer: PHCS Commercial |
$2,895.89
|
| Rate for Payer: United Healthcare All Payer |
$2,654.56
|
|
|
CATH BALLOON UROMAX 18FR
|
Facility
|
OP
|
$3,016.55
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$904.97 |
| Max. Negotiated Rate |
$2,895.89 |
| Rate for Payer: Aetna Commercial |
$2,322.74
|
| Rate for Payer: Anthem Medicaid |
$1,037.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,352.91
|
| Rate for Payer: Cash Price |
$1,508.28
|
| Rate for Payer: Cigna Commercial |
$2,503.74
|
| Rate for Payer: First Health Commercial |
$2,865.72
|
| Rate for Payer: Humana Commercial |
$2,564.07
|
| Rate for Payer: Humana KY Medicaid |
$1,037.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,047.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,473.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,226.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$904.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,058.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,654.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,262.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,413.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,624.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,081.42
|
| Rate for Payer: PHCS Commercial |
$2,895.89
|
| Rate for Payer: United Healthcare All Payer |
$2,654.56
|
|
