|
CURETTAGE, POSTPARTUM
|
Professional
|
Both
|
$5,185.00
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$124.38 |
| Max. Negotiated Rate |
$5,185.00 |
| Rate for Payer: Aetna Commercial |
$295.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$124.38
|
| Rate for Payer: Anthem Medicaid |
$169.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,185.00
|
| Rate for Payer: Cash Price |
$2,592.50
|
| Rate for Payer: Cash Price |
$2,592.50
|
| Rate for Payer: Cigna Commercial |
$293.19
|
| Rate for Payer: Healthspan PPO |
$250.26
|
| Rate for Payer: Humana Medicaid |
$169.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$234.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.67
|
| Rate for Payer: Molina Healthcare Passport |
$169.28
|
| Rate for Payer: Multiplan PHCS |
$3,111.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,629.50
|
| Rate for Payer: UHCCP Medicaid |
$130.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.97
|
|
|
CURETTAGE, POSTPARTUM
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 59160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
CURETTAGE, POSTPARTUM(P
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
720P0011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$124.38 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$295.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$124.38
|
| Rate for Payer: Anthem Medicaid |
$169.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$293.19
|
| Rate for Payer: Healthspan PPO |
$250.26
|
| Rate for Payer: Humana Medicaid |
$169.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$234.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.67
|
| Rate for Payer: Molina Healthcare Passport |
$169.28
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$130.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.97
|
|
|
CURETTAGE, POSTPARTUM(T
|
Facility
|
IP
|
$4,405.00
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
720T0011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$572.65 |
| Max. Negotiated Rate |
$4,228.80 |
| Rate for Payer: Aetna Commercial |
$3,391.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,435.90
|
| Rate for Payer: Cash Price |
$2,202.50
|
| Rate for Payer: Cigna Commercial |
$3,656.15
|
| Rate for Payer: First Health Commercial |
$4,184.75
|
| Rate for Payer: Humana Commercial |
$3,744.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,612.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,250.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,321.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,876.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$881.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$572.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,365.55
|
| Rate for Payer: PHCS Commercial |
$4,228.80
|
| Rate for Payer: United Healthcare All Payer |
$3,876.40
|
|
|
CURETTAGE, POSTPARTUM(T
|
Facility
|
OP
|
$4,405.00
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
720T0011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$572.65 |
| Max. Negotiated Rate |
$4,228.80 |
| Rate for Payer: Aetna Commercial |
$3,391.85
|
| Rate for Payer: Anthem Medicaid |
$1,514.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,435.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,202.50
|
| Rate for Payer: Cash Price |
$2,202.50
|
| Rate for Payer: Cigna Commercial |
$3,656.15
|
| Rate for Payer: First Health Commercial |
$4,184.75
|
| Rate for Payer: Humana Commercial |
$3,744.25
|
| Rate for Payer: Humana KY Medicaid |
$1,514.88
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,530.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,612.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,250.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,545.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,876.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$881.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$572.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,365.55
|
| Rate for Payer: PHCS Commercial |
$4,228.80
|
| Rate for Payer: United Healthcare All Payer |
$3,876.40
|
|
|
CUROSURF 240 MG / 3 ML VIAL
|
Facility
|
IP
|
$1,018.09
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25002972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$977.37 |
| Rate for Payer: Aetna Commercial |
$783.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$794.11
|
| Rate for Payer: Cash Price |
$509.04
|
| Rate for Payer: Cigna Commercial |
$845.01
|
| Rate for Payer: First Health Commercial |
$967.19
|
| Rate for Payer: Humana Commercial |
$865.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$834.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$751.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$305.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$895.92
|
| Rate for Payer: Ohio Health Group HMO |
$763.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$203.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.61
|
| Rate for Payer: PHCS Commercial |
$977.37
|
| Rate for Payer: United Healthcare All Payer |
$895.92
|
|
|
CUROSURF 240 MG / 3 ML VIAL
|
Facility
|
OP
|
$1,018.09
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25002972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$977.37 |
| Rate for Payer: Aetna Commercial |
$783.93
|
| Rate for Payer: Anthem Medicaid |
$350.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$794.11
|
| Rate for Payer: Cash Price |
$509.04
|
| Rate for Payer: Cigna Commercial |
$845.01
|
| Rate for Payer: First Health Commercial |
$967.19
|
| Rate for Payer: Humana Commercial |
$865.38
|
| Rate for Payer: Humana KY Medicaid |
$350.12
|
| Rate for Payer: Kentucky WC Medicaid |
$353.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$834.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$751.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$305.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$357.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$895.92
|
| Rate for Payer: Ohio Health Group HMO |
$763.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$203.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.61
|
| Rate for Payer: PHCS Commercial |
$977.37
|
| Rate for Payer: United Healthcare All Payer |
$895.92
|
|
|
CUSTODIOL PERFUSION SOLUTION
|
Facility
|
OP
|
$311.52
|
|
|
Service Code
|
NDC 25767073545
|
| Hospital Charge Code |
25002973
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$299.06 |
| Rate for Payer: Kentucky WC Medicaid |
$108.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$255.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$229.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$274.14
|
| Rate for Payer: Ohio Health Group HMO |
$233.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.57
|
| Rate for Payer: PHCS Commercial |
$299.06
|
| Rate for Payer: United Healthcare All Payer |
$274.14
|
| Rate for Payer: Aetna Commercial |
$239.87
|
| Rate for Payer: Anthem Medicaid |
$107.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$242.99
|
| Rate for Payer: Cash Price |
$155.76
|
| Rate for Payer: Cigna Commercial |
$258.56
|
| Rate for Payer: First Health Commercial |
$295.94
|
| Rate for Payer: Humana Commercial |
$264.79
|
| Rate for Payer: Humana KY Medicaid |
$107.13
|
|
|
CUSTODIOL PERFUSION SOLUTION
|
Facility
|
IP
|
$311.52
|
|
|
Service Code
|
NDC 25767073545
|
| Hospital Charge Code |
25002973
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$299.06 |
| Rate for Payer: Aetna Commercial |
$239.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$242.99
|
| Rate for Payer: Cash Price |
$155.76
|
| Rate for Payer: Cigna Commercial |
$258.56
|
| Rate for Payer: First Health Commercial |
$295.94
|
| Rate for Payer: Humana Commercial |
$264.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$255.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$229.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$274.14
|
| Rate for Payer: Ohio Health Group HMO |
$233.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.57
|
| Rate for Payer: PHCS Commercial |
$299.06
|
| Rate for Payer: United Healthcare All Payer |
$274.14
|
|
|
CUSTOM HUM STEM 6*160MM
|
Facility
|
OP
|
$24,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,233.75 |
| Max. Negotiated Rate |
$23,880.00 |
| Rate for Payer: Aetna Commercial |
$19,153.75
|
| Rate for Payer: Anthem Medicaid |
$8,554.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,402.50
|
| Rate for Payer: Cash Price |
$12,437.50
|
| Rate for Payer: Cigna Commercial |
$20,646.25
|
| Rate for Payer: First Health Commercial |
$23,631.25
|
| Rate for Payer: Humana Commercial |
$21,143.75
|
| Rate for Payer: Humana KY Medicaid |
$8,554.51
|
| Rate for Payer: Kentucky WC Medicaid |
$8,641.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,397.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,357.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,726.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,890.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,233.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,711.25
|
| Rate for Payer: PHCS Commercial |
$23,880.00
|
| Rate for Payer: United Healthcare All Payer |
$21,890.00
|
|
|
CUSTOM HUM STEM 6*160MM
|
Facility
|
IP
|
$24,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,233.75 |
| Max. Negotiated Rate |
$23,880.00 |
| Rate for Payer: Aetna Commercial |
$19,153.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,402.50
|
| Rate for Payer: Cash Price |
$12,437.50
|
| Rate for Payer: Cigna Commercial |
$20,646.25
|
| Rate for Payer: First Health Commercial |
$23,631.25
|
| Rate for Payer: Humana Commercial |
$21,143.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,397.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,357.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,890.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,233.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,711.25
|
| Rate for Payer: PHCS Commercial |
$23,880.00
|
| Rate for Payer: United Healthcare All Payer |
$21,890.00
|
|
|
CUSTOM SLEEVE
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
CUSTOM SLEEVE
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
CUTTING BALLOON 2*1.5
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
CUTTING BALLOON 2*1.5
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
CUTTING BALLOON 2.5*1.5
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
CUTTING BALLOON 2.5*1.5
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
CUTTING BALLOON 3*1.5
|
Facility
|
OP
|
$4,662.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.09 |
| Max. Negotiated Rate |
$4,475.76 |
| Rate for Payer: Aetna Commercial |
$3,589.93
|
| Rate for Payer: Anthem Medicaid |
$1,603.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,636.56
|
| Rate for Payer: Cash Price |
$2,331.12
|
| Rate for Payer: Cigna Commercial |
$3,869.67
|
| Rate for Payer: First Health Commercial |
$4,429.14
|
| Rate for Payer: Humana Commercial |
$3,962.91
|
| Rate for Payer: Humana KY Medicaid |
$1,603.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,619.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,823.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,440.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,398.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,635.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,102.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,496.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,445.30
|
| Rate for Payer: PHCS Commercial |
$4,475.76
|
| Rate for Payer: United Healthcare All Payer |
$4,102.78
|
|
|
CUTTING BALLOON 3*1.5
|
Facility
|
IP
|
$4,662.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.09 |
| Max. Negotiated Rate |
$4,475.76 |
| Rate for Payer: Aetna Commercial |
$3,589.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,636.56
|
| Rate for Payer: Cash Price |
$2,331.12
|
| Rate for Payer: Cigna Commercial |
$3,869.67
|
| Rate for Payer: First Health Commercial |
$4,429.14
|
| Rate for Payer: Humana Commercial |
$3,962.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,823.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,440.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,398.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,102.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,496.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,445.30
|
| Rate for Payer: PHCS Commercial |
$4,475.76
|
| Rate for Payer: United Healthcare All Payer |
$4,102.78
|
|
|
CUTTING BALLOON 3.5*1.5
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
CUTTING BALLOON 3.5*1.5
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
CUTTING BALLOON 5*2*135
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
CUTTING BALLOON 5*2*135
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
CUTTING BALLOON 5*2*50
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
CUTTING BALLOON 5*2*50
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
