|
DILATION PAROTID DUCT
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 42660
|
| Hospital Charge Code |
76101695
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
DILATION PAROTID DUCT
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 42660
|
| Hospital Charge Code |
76101695
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$114.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.55
|
| Rate for Payer: Anthem Medicaid |
$41.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$144.54
|
| Rate for Payer: Healthspan PPO |
$125.42
|
| Rate for Payer: Humana Medicaid |
$41.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.15
|
| Rate for Payer: Molina Healthcare Passport |
$41.32
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$69.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.73
|
|
|
DILATION PAROTID DUCT
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 42660
|
| Hospital Charge Code |
76101695
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$51.58
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$52.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
DILATION PAROTID DUCT(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 42660
|
| Hospital Charge Code |
761P1695
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$114.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.55
|
| Rate for Payer: Anthem Medicaid |
$41.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$144.54
|
| Rate for Payer: Healthspan PPO |
$125.42
|
| Rate for Payer: Humana Medicaid |
$41.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.15
|
| Rate for Payer: Molina Healthcare Passport |
$41.32
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$69.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.73
|
|
|
DILATION SALIVARY DUCT
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 42650
|
| Hospital Charge Code |
76101694
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$85.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.96
|
| Rate for Payer: Anthem Medicaid |
$28.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$109.80
|
| Rate for Payer: Healthspan PPO |
$97.21
|
| Rate for Payer: Humana Medicaid |
$28.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.38
|
| Rate for Payer: Molina Healthcare Passport |
$28.80
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$53.51
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.09
|
|
|
DILATION SALIVARY DUCT
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 42650
|
| Hospital Charge Code |
76101694
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
DILATION SALIVARY DUCT
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 42650
|
| Hospital Charge Code |
76101694
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
DILATION SALIVARY DUCT(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 42650
|
| Hospital Charge Code |
761P1694
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$85.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.96
|
| Rate for Payer: Anthem Medicaid |
$28.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$109.80
|
| Rate for Payer: Healthspan PPO |
$97.21
|
| Rate for Payer: Humana Medicaid |
$28.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.38
|
| Rate for Payer: Molina Healthcare Passport |
$28.80
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$53.51
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.09
|
|
|
DILATOR 14F 45CM CATH LAB
|
Facility
|
OP
|
$1,962.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$1,511.12
|
| Rate for Payer: Anthem Medicaid |
$674.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
| Rate for Payer: Cash Price |
$981.25
|
| Rate for Payer: Cigna Commercial |
$1,628.88
|
| Rate for Payer: First Health Commercial |
$1,864.38
|
| Rate for Payer: Humana Commercial |
$1,668.12
|
| Rate for Payer: Humana KY Medicaid |
$674.90
|
| Rate for Payer: Kentucky WC Medicaid |
$681.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$688.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
| Rate for Payer: PHCS Commercial |
$1,884.00
|
| Rate for Payer: United Healthcare All Payer |
$1,727.00
|
|
|
DILATOR 14F 45CM CATH LAB
|
Facility
|
IP
|
$1,962.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$1,511.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
| Rate for Payer: Cash Price |
$981.25
|
| Rate for Payer: Cigna Commercial |
$1,628.88
|
| Rate for Payer: First Health Commercial |
$1,864.38
|
| Rate for Payer: Humana Commercial |
$1,668.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
| Rate for Payer: PHCS Commercial |
$1,884.00
|
| Rate for Payer: United Healthcare All Payer |
$1,727.00
|
|
|
DILATOR 16/18F 45CM
|
Facility
|
IP
|
$2,151.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.70 |
| Max. Negotiated Rate |
$2,065.44 |
| Rate for Payer: Aetna Commercial |
$1,656.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,678.17
|
| Rate for Payer: Cash Price |
$1,075.75
|
| Rate for Payer: Cigna Commercial |
$1,785.74
|
| Rate for Payer: First Health Commercial |
$2,043.92
|
| Rate for Payer: Humana Commercial |
$1,828.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,764.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,587.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,893.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,613.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$666.96
|
| Rate for Payer: PHCS Commercial |
$2,065.44
|
| Rate for Payer: United Healthcare All Payer |
$1,893.32
|
|
|
DILATOR 16/18F 45CM
|
Facility
|
OP
|
$2,151.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.70 |
| Max. Negotiated Rate |
$2,065.44 |
| Rate for Payer: Aetna Commercial |
$1,656.66
|
| Rate for Payer: Anthem Medicaid |
$739.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,678.17
|
| Rate for Payer: Cash Price |
$1,075.75
|
| Rate for Payer: Cigna Commercial |
$1,785.74
|
| Rate for Payer: First Health Commercial |
$2,043.92
|
| Rate for Payer: Humana Commercial |
$1,828.78
|
| Rate for Payer: Humana KY Medicaid |
$739.90
|
| Rate for Payer: Kentucky WC Medicaid |
$747.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,764.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,587.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$754.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,893.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,613.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$666.96
|
| Rate for Payer: PHCS Commercial |
$2,065.44
|
| Rate for Payer: United Healthcare All Payer |
$1,893.32
|
|
|
DILATOR 5F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 5F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
| 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
|
|
|
DILATOR 6F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 6F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 6FR .038
|
Facility
|
IP
|
$1,078.16
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$1,035.03 |
| Rate for Payer: Aetna Commercial |
$830.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.96
|
| Rate for Payer: Cash Price |
$539.08
|
| Rate for Payer: Cigna Commercial |
$894.87
|
| Rate for Payer: First Health Commercial |
$1,024.25
|
| Rate for Payer: Humana Commercial |
$916.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$884.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.78
|
| Rate for Payer: Ohio Health Group HMO |
$808.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.23
|
| Rate for Payer: PHCS Commercial |
$1,035.03
|
| Rate for Payer: United Healthcare All Payer |
$948.78
|
|
|
DILATOR 6FR .038
|
Facility
|
OP
|
$1,078.16
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$1,035.03 |
| Rate for Payer: Aetna Commercial |
$830.18
|
| Rate for Payer: Anthem Medicaid |
$370.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.96
|
| Rate for Payer: Cash Price |
$539.08
|
| Rate for Payer: Cigna Commercial |
$894.87
|
| Rate for Payer: First Health Commercial |
$1,024.25
|
| Rate for Payer: Humana Commercial |
$916.44
|
| Rate for Payer: Humana KY Medicaid |
$370.78
|
| Rate for Payer: Kentucky WC Medicaid |
$374.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$884.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.78
|
| Rate for Payer: Ohio Health Group HMO |
$808.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.23
|
| Rate for Payer: PHCS Commercial |
$1,035.03
|
| Rate for Payer: United Healthcare All Payer |
$948.78
|
|
|
DILATOR 7F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 7F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 8F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
| 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
|
|
|
DILATOR 8F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR BALLOON 225-136
|
Facility
|
IP
|
$3,148.78
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.34 |
| Max. Negotiated Rate |
$3,022.83 |
| Rate for Payer: Aetna Commercial |
$2,424.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,456.05
|
| Rate for Payer: Cash Price |
$1,574.39
|
| Rate for Payer: Cigna Commercial |
$2,613.49
|
| Rate for Payer: First Health Commercial |
$2,991.34
|
| Rate for Payer: Humana Commercial |
$2,676.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,323.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,770.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,361.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$976.12
|
| Rate for Payer: PHCS Commercial |
$3,022.83
|
| Rate for Payer: United Healthcare All Payer |
$2,770.93
|
|
|
DILATOR BALLOON 225-136
|
Facility
|
OP
|
$3,148.78
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.34 |
| Max. Negotiated Rate |
$3,022.83 |
| Rate for Payer: Aetna Commercial |
$2,424.56
|
| Rate for Payer: Anthem Medicaid |
$1,082.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,456.05
|
| Rate for Payer: Cash Price |
$1,574.39
|
| Rate for Payer: Cigna Commercial |
$2,613.49
|
| Rate for Payer: First Health Commercial |
$2,991.34
|
| Rate for Payer: Humana Commercial |
$2,676.46
|
| Rate for Payer: Humana KY Medicaid |
$1,082.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,323.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,104.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,770.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,361.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$976.12
|
| Rate for Payer: PHCS Commercial |
$3,022.83
|
| Rate for Payer: United Healthcare All Payer |
$2,770.93
|
|
|
DILATOR BALLOON CRE 12-15MM
|
Facility
|
IP
|
$1,921.58
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.81 |
| Max. Negotiated Rate |
$1,844.72 |
| Rate for Payer: Aetna Commercial |
$1,479.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,498.83
|
| Rate for Payer: Cash Price |
$960.79
|
| Rate for Payer: Cigna Commercial |
$1,594.91
|
| Rate for Payer: First Health Commercial |
$1,825.50
|
| Rate for Payer: Humana Commercial |
$1,633.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,575.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,418.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,441.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.69
|
| Rate for Payer: PHCS Commercial |
$1,844.72
|
| Rate for Payer: United Healthcare All Payer |
$1,690.99
|
|
