|
CATH BALLOON XXL*12*2*5.8*75
|
Facility
|
IP
|
$3,089.22
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$926.77 |
| Max. Negotiated Rate |
$2,965.65 |
| Rate for Payer: Aetna Commercial |
$2,378.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,409.59
|
| Rate for Payer: Cash Price |
$1,544.61
|
| Rate for Payer: Cigna Commercial |
$2,564.05
|
| Rate for Payer: First Health Commercial |
$2,934.76
|
| Rate for Payer: Humana Commercial |
$2,625.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,533.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,279.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,718.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,316.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,471.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,687.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,131.56
|
| Rate for Payer: PHCS Commercial |
$2,965.65
|
| Rate for Payer: United Healthcare All Payer |
$2,718.51
|
|
|
CATH BALLOON XXL*12*2*5.8*75
|
Facility
|
OP
|
$3,089.22
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$926.77 |
| Max. Negotiated Rate |
$2,965.65 |
| Rate for Payer: Aetna Commercial |
$2,378.70
|
| Rate for Payer: Anthem Medicaid |
$1,062.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,409.59
|
| Rate for Payer: Cash Price |
$1,544.61
|
| Rate for Payer: Cigna Commercial |
$2,564.05
|
| Rate for Payer: First Health Commercial |
$2,934.76
|
| Rate for Payer: Humana Commercial |
$2,625.84
|
| Rate for Payer: Humana KY Medicaid |
$1,062.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,073.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,533.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,279.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,083.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,718.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,316.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,471.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,687.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,131.56
|
| Rate for Payer: PHCS Commercial |
$2,965.65
|
| Rate for Payer: United Healthcare All Payer |
$2,718.51
|
|
|
CATH BALLOON XXL 12*4
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
CATH BALLOON XXL 12*4
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
CATH BALLOON XXL*14*2*5.8*75
|
Facility
|
IP
|
$3,089.22
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$926.77 |
| Max. Negotiated Rate |
$2,965.65 |
| Rate for Payer: Aetna Commercial |
$2,378.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,409.59
|
| Rate for Payer: Cash Price |
$1,544.61
|
| Rate for Payer: Cigna Commercial |
$2,564.05
|
| Rate for Payer: First Health Commercial |
$2,934.76
|
| Rate for Payer: Humana Commercial |
$2,625.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,533.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,279.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,718.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,316.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,471.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,687.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,131.56
|
| Rate for Payer: PHCS Commercial |
$2,965.65
|
| Rate for Payer: United Healthcare All Payer |
$2,718.51
|
|
|
CATH BALLOON XXL*14*2*5.8*75
|
Facility
|
OP
|
$3,089.22
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$926.77 |
| Max. Negotiated Rate |
$2,965.65 |
| Rate for Payer: Aetna Commercial |
$2,378.70
|
| Rate for Payer: Anthem Medicaid |
$1,062.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,409.59
|
| Rate for Payer: Cash Price |
$1,544.61
|
| Rate for Payer: Cigna Commercial |
$2,564.05
|
| Rate for Payer: First Health Commercial |
$2,934.76
|
| Rate for Payer: Humana Commercial |
$2,625.84
|
| Rate for Payer: Humana KY Medicaid |
$1,062.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,073.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,533.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,279.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,083.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,718.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,316.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,471.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,687.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,131.56
|
| Rate for Payer: PHCS Commercial |
$2,965.65
|
| Rate for Payer: United Healthcare All Payer |
$2,718.51
|
|
|
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 |
$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 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 |
$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 BALOON ULTRA THIN 10*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 BALOON ULTRA THIN 10*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 BALOON ULTRA THIN 10*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 BALOON ULTRA THIN 10*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 BALOON ULTRA THIN 4*2*90
|
Facility
|
OP
|
$2,025.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$607.74 |
| Max. Negotiated Rate |
$1,944.77 |
| Rate for Payer: Aetna Commercial |
$1,559.87
|
| Rate for Payer: Anthem Medicaid |
$696.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.12
|
| Rate for Payer: Cash Price |
$1,012.90
|
| Rate for Payer: Cigna Commercial |
$1,681.41
|
| Rate for Payer: First Health Commercial |
$1,924.51
|
| Rate for Payer: Humana Commercial |
$1,721.93
|
| Rate for Payer: Humana KY Medicaid |
$696.67
|
| Rate for Payer: Kentucky WC Medicaid |
$703.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,762.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.80
|
| Rate for Payer: PHCS Commercial |
$1,944.77
|
| Rate for Payer: United Healthcare All Payer |
$1,782.70
|
|
|
CATH BALOON ULTRA THIN 4*2*90
|
Facility
|
IP
|
$2,025.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$607.74 |
| Max. Negotiated Rate |
$1,944.77 |
| Rate for Payer: Aetna Commercial |
$1,559.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.12
|
| Rate for Payer: Cash Price |
$1,012.90
|
| Rate for Payer: Cigna Commercial |
$1,681.41
|
| Rate for Payer: First Health Commercial |
$1,924.51
|
| Rate for Payer: Humana Commercial |
$1,721.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,762.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.80
|
| Rate for Payer: PHCS Commercial |
$1,944.77
|
| Rate for Payer: United Healthcare All Payer |
$1,782.70
|
|
|
CATH BALOON ULTRA THIN 6*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 BALOON ULTRA THIN 6*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 BARRX ENDO TTS-1100
|
Facility
|
IP
|
$10,102.90
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,030.87 |
| Max. Negotiated Rate |
$9,698.78 |
| Rate for Payer: Aetna Commercial |
$7,779.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,880.26
|
| Rate for Payer: Cash Price |
$5,051.45
|
| Rate for Payer: Cigna Commercial |
$8,385.41
|
| Rate for Payer: First Health Commercial |
$9,597.75
|
| Rate for Payer: Humana Commercial |
$8,587.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,284.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,455.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,030.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,890.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,577.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,082.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,789.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,971.00
|
| Rate for Payer: PHCS Commercial |
$9,698.78
|
| Rate for Payer: United Healthcare All Payer |
$8,890.55
|
|
|
CATH BARRX ENDO TTS-1100
|
Facility
|
OP
|
$10,102.90
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,030.87 |
| Max. Negotiated Rate |
$9,698.78 |
| Rate for Payer: Aetna Commercial |
$7,779.23
|
| Rate for Payer: Anthem Medicaid |
$3,474.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,880.26
|
| Rate for Payer: Cash Price |
$5,051.45
|
| Rate for Payer: Cigna Commercial |
$8,385.41
|
| Rate for Payer: First Health Commercial |
$9,597.75
|
| Rate for Payer: Humana Commercial |
$8,587.47
|
| Rate for Payer: Humana KY Medicaid |
$3,474.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,509.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,284.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,455.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,030.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,544.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,890.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,577.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,082.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,789.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,971.00
|
| Rate for Payer: PHCS Commercial |
$9,698.78
|
| Rate for Payer: United Healthcare All Payer |
$8,890.55
|
|
|
CATH CAV DRN KIT AK-01600 CVD
|
Facility
|
OP
|
$1,762.25
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$528.67 |
| Max. Negotiated Rate |
$1,691.76 |
| Rate for Payer: Aetna Commercial |
$1,356.93
|
| Rate for Payer: Anthem Medicaid |
$606.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,374.56
|
| Rate for Payer: Cash Price |
$881.12
|
| Rate for Payer: Cigna Commercial |
$1,462.67
|
| Rate for Payer: First Health Commercial |
$1,674.14
|
| Rate for Payer: Humana Commercial |
$1,497.91
|
| Rate for Payer: Humana KY Medicaid |
$606.04
|
| Rate for Payer: Kentucky WC Medicaid |
$612.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$618.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,550.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,321.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,409.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.95
|
| Rate for Payer: PHCS Commercial |
$1,691.76
|
| Rate for Payer: United Healthcare All Payer |
$1,550.78
|
|
|
CATH CAV DRN KIT AK-01600 CVD
|
Facility
|
IP
|
$1,762.25
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$528.67 |
| Max. Negotiated Rate |
$1,691.76 |
| Rate for Payer: Aetna Commercial |
$1,356.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,374.56
|
| Rate for Payer: Cash Price |
$881.12
|
| Rate for Payer: Cigna Commercial |
$1,462.67
|
| Rate for Payer: First Health Commercial |
$1,674.14
|
| Rate for Payer: Humana Commercial |
$1,497.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,550.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,321.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,409.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.95
|
| Rate for Payer: PHCS Commercial |
$1,691.76
|
| Rate for Payer: United Healthcare All Payer |
$1,550.78
|
|
|
CATH CLOSURE 6FR*100CM
|
Facility
|
OP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem Medicaid |
$1,622.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Humana KY Medicaid |
$1,622.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
|
CATH CLOSURE 6FR*100CM
|
Facility
|
IP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
IP
|
$9,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
761T1446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,941.50 |
| Max. Negotiated Rate |
$9,412.80 |
| Rate for Payer: Aetna Commercial |
$7,549.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,647.90
|
| Rate for Payer: Cash Price |
$4,902.50
|
| Rate for Payer: Cigna Commercial |
$8,138.15
|
| Rate for Payer: First Health Commercial |
$9,314.75
|
| Rate for Payer: Humana Commercial |
$8,334.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,040.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,236.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,628.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,844.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,530.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,765.45
|
| Rate for Payer: PHCS Commercial |
$9,412.80
|
| Rate for Payer: United Healthcare All Payer |
$8,628.40
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
IP
|
$13,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
76101446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,141.50 |
| Max. Negotiated Rate |
$13,252.80 |
| Rate for Payer: Aetna Commercial |
$10,629.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,767.90
|
| Rate for Payer: Cash Price |
$6,902.50
|
| Rate for Payer: Cigna Commercial |
$11,458.15
|
| Rate for Payer: First Health Commercial |
$13,114.75
|
| Rate for Payer: Humana Commercial |
$11,734.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,320.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,188.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,141.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,148.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,044.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,010.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,525.45
|
| Rate for Payer: PHCS Commercial |
$13,252.80
|
| Rate for Payer: United Healthcare All Payer |
$12,148.40
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Professional
|
Both
|
$11,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
76101445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.24 |
| Max. Negotiated Rate |
$7,083.00 |
| Rate for Payer: Ambetter Exchange |
$312.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.24
|
| Rate for Payer: Anthem Medicaid |
$1,213.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$312.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$312.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$375.28
|
| Rate for Payer: Cash Price |
$5,902.50
|
| Rate for Payer: Cash Price |
$5,902.50
|
| Rate for Payer: Cigna Commercial |
$590.71
|
| Rate for Payer: Healthspan PPO |
$1,861.09
|
| Rate for Payer: Humana Medicaid |
$1,213.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$312.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,237.94
|
| Rate for Payer: Molina Healthcare Passport |
$1,213.67
|
| Rate for Payer: Multiplan PHCS |
$7,083.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$406.55
|
| Rate for Payer: UHCCP Medicaid |
$194.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,225.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$312.73
|
|
