|
DILATOR BALLOON CRE 12-15MM
|
Facility
|
OP
|
$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 Medicaid |
$660.83
|
| 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: Humana KY Medicaid |
$660.83
|
| Rate for Payer: Kentucky WC Medicaid |
$667.56
|
| 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: Molina Healthcare Medicaid |
$674.09
|
| 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
|
|
|
DILATOR BALLOON CRE 15-18MM
|
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
|
|
|
DILATOR BALLOON CRE 15-18MM
|
Facility
|
OP
|
$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 Medicaid |
$660.83
|
| 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: Humana KY Medicaid |
$660.83
|
| Rate for Payer: Kentucky WC Medicaid |
$667.56
|
| 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: Molina Healthcare Medicaid |
$674.09
|
| 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
|
|
|
DILATOR BALLOON CRE 18-20MM
|
Facility
|
IP
|
$1,973.70
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.58 |
| Max. Negotiated Rate |
$1,894.75 |
| Rate for Payer: Aetna Commercial |
$1,519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,539.49
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: Cigna Commercial |
$1,638.17
|
| Rate for Payer: First Health Commercial |
$1,875.02
|
| Rate for Payer: Humana Commercial |
$1,677.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,618.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,736.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,480.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.85
|
| Rate for Payer: PHCS Commercial |
$1,894.75
|
| Rate for Payer: United Healthcare All Payer |
$1,736.86
|
|
|
DILATOR BALLOON CRE 18-20MM
|
Facility
|
OP
|
$1,973.70
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.58 |
| Max. Negotiated Rate |
$1,894.75 |
| Rate for Payer: Aetna Commercial |
$1,519.75
|
| Rate for Payer: Anthem Medicaid |
$678.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,539.49
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: Cigna Commercial |
$1,638.17
|
| Rate for Payer: First Health Commercial |
$1,875.02
|
| Rate for Payer: Humana Commercial |
$1,677.64
|
| Rate for Payer: Humana KY Medicaid |
$678.76
|
| Rate for Payer: Kentucky WC Medicaid |
$685.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,618.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$692.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,736.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,480.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.85
|
| Rate for Payer: PHCS Commercial |
$1,894.75
|
| Rate for Payer: United Healthcare All Payer |
$1,736.86
|
|
|
DILATOR COAXIAL 8/10
|
Facility
|
OP
|
$780.27
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$749.06 |
| Rate for Payer: Aetna Commercial |
$600.81
|
| Rate for Payer: Anthem Medicaid |
$268.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.61
|
| Rate for Payer: Cash Price |
$390.14
|
| Rate for Payer: Cigna Commercial |
$647.62
|
| Rate for Payer: First Health Commercial |
$741.26
|
| Rate for Payer: Humana Commercial |
$663.23
|
| Rate for Payer: Humana KY Medicaid |
$268.33
|
| Rate for Payer: Kentucky WC Medicaid |
$271.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.64
|
| Rate for Payer: Ohio Health Group HMO |
$585.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.88
|
| Rate for Payer: PHCS Commercial |
$749.06
|
| Rate for Payer: United Healthcare All Payer |
$686.64
|
|
|
DILATOR COAXIAL 8/10
|
Facility
|
IP
|
$780.27
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$749.06 |
| Rate for Payer: Aetna Commercial |
$600.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.61
|
| Rate for Payer: Cash Price |
$390.14
|
| Rate for Payer: Cigna Commercial |
$647.62
|
| Rate for Payer: First Health Commercial |
$741.26
|
| Rate for Payer: Humana Commercial |
$663.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.64
|
| Rate for Payer: Ohio Health Group HMO |
$585.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.88
|
| Rate for Payer: PHCS Commercial |
$749.06
|
| Rate for Payer: United Healthcare All Payer |
$686.64
|
|
|
DILATOR RENAL AMPLATZ 10*3
|
Facility
|
IP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 10*3
|
Facility
|
OP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem Medicaid |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Humana KY Medicaid |
$266.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 14*8
|
Facility
|
IP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 14*8
|
Facility
|
OP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem Medicaid |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Humana KY Medicaid |
$266.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 18*8
|
Facility
|
IP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 18*8
|
Facility
|
OP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem Medicaid |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Humana KY Medicaid |
$266.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 22*8
|
Facility
|
IP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 22*8
|
Facility
|
OP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem Medicaid |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Humana KY Medicaid |
$266.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 24FR
|
Facility
|
OP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem Medicaid |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Humana KY Medicaid |
$266.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 24FR
|
Facility
|
IP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 26*8
|
Facility
|
OP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem Medicaid |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Humana KY Medicaid |
$266.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 26*8
|
Facility
|
IP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 28FR
|
Facility
|
OP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem Medicaid |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Humana KY Medicaid |
$266.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 28FR
|
Facility
|
IP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 30FR
|
Facility
|
IP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILATOR RENAL AMPLATZ 30FR
|
Facility
|
OP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem Medicaid |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Humana KY Medicaid |
$266.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
DILAT URETH STRIX DIL MALE 1ST
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 53600
|
| Hospital Charge Code |
76102117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Aetna Commercial |
$106.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.94
|
| Rate for Payer: Anthem Medicaid |
$40.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$929.00
|
| Rate for Payer: Cash Price |
$464.50
|
| Rate for Payer: Cash Price |
$464.50
|
| Rate for Payer: Cigna Commercial |
$132.86
|
| Rate for Payer: Healthspan PPO |
$111.05
|
| Rate for Payer: Humana Medicaid |
$40.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.47
|
| Rate for Payer: Molina Healthcare Passport |
$40.66
|
| Rate for Payer: Multiplan PHCS |
$557.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$650.30
|
| Rate for Payer: UHCCP Medicaid |
$42.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.07
|
|
|
DILAT URETH STRIX DIL MALE 1ST
|
Facility
|
IP
|
$929.00
|
|
|
Service Code
|
HCPCS 53600
|
| Hospital Charge Code |
76102117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$891.84 |
| Rate for Payer: Aetna Commercial |
$715.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$724.62
|
| Rate for Payer: Cash Price |
$464.50
|
| Rate for Payer: Cigna Commercial |
$771.07
|
| Rate for Payer: First Health Commercial |
$882.55
|
| Rate for Payer: Humana Commercial |
$789.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$761.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$685.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$817.52
|
| Rate for Payer: Ohio Health Group HMO |
$696.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.99
|
| Rate for Payer: PHCS Commercial |
$891.84
|
| Rate for Payer: United Healthcare All Payer |
$817.52
|
|
