|
AERO TRACHEOBRONCH STENT 14*3
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 14*40
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
AERO TRACHEOBRONCH STENT 14*40
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
AERO TRACHEOBRONCH STENT 16*40
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 16*40
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 16*80
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
AERO TRACHEOBRONCH STENT 16*80
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
AERO TRACHEOBRONCH STENT 18*40
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
AERO TRACHEOBRONCH STENT 18*40
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
AERO TRACHEOBRONCH STENT 18*80
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
AERO TRACHEOBRONCH STENT 18*80
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
AFFINITY 2.5X2.5CM
|
Facility
|
IP
|
$12,491.50
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
27000257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
AFFINITY 2.5X2.5CM
|
Facility
|
OP
|
$12,491.50
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
27000257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem Medicaid |
$4,295.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Humana KY Medicaid |
$4,295.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,339.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,382.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
AFFIXUS BALLNSE GUIDEWIRE 80C
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem Medicaid |
$1,048.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Humana KY Medicaid |
$1,048.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,059.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,069.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
AFFIXUS BALLNSE GUIDEWIRE 80C
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
AFFIXUS GUIDE PIN THRD 3.2MM
|
Facility
|
OP
|
$1,878.17
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$563.45 |
| Max. Negotiated Rate |
$1,803.04 |
| Rate for Payer: Aetna Commercial |
$1,446.19
|
| Rate for Payer: Anthem Medicaid |
$645.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.97
|
| Rate for Payer: Cash Price |
$939.08
|
| Rate for Payer: Cigna Commercial |
$1,558.88
|
| Rate for Payer: First Health Commercial |
$1,784.26
|
| Rate for Payer: Humana Commercial |
$1,596.44
|
| Rate for Payer: Humana KY Medicaid |
$645.90
|
| Rate for Payer: Kentucky WC Medicaid |
$652.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,634.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.94
|
| Rate for Payer: PHCS Commercial |
$1,803.04
|
| Rate for Payer: United Healthcare All Payer |
$1,652.79
|
|
|
AFFIXUS GUIDE PIN THRD 3.2MM
|
Facility
|
IP
|
$1,878.17
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$563.45 |
| Max. Negotiated Rate |
$1,803.04 |
| Rate for Payer: Aetna Commercial |
$1,446.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.97
|
| Rate for Payer: Cash Price |
$939.08
|
| Rate for Payer: Cigna Commercial |
$1,558.88
|
| Rate for Payer: First Health Commercial |
$1,784.26
|
| Rate for Payer: Humana Commercial |
$1,596.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,634.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.94
|
| Rate for Payer: PHCS Commercial |
$1,803.04
|
| Rate for Payer: United Healthcare All Payer |
$1,652.79
|
|
|
AFFIXUS GUIDWIR BALL NOSE 100C
|
Facility
|
IP
|
$3,012.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$903.75 |
| Max. Negotiated Rate |
$2,892.00 |
| Rate for Payer: Aetna Commercial |
$2,319.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,349.75
|
| Rate for Payer: Cash Price |
$1,506.25
|
| Rate for Payer: Cigna Commercial |
$2,500.38
|
| Rate for Payer: First Health Commercial |
$2,861.88
|
| Rate for Payer: Humana Commercial |
$2,560.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,470.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,223.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$903.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,651.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,259.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.62
|
| Rate for Payer: PHCS Commercial |
$2,892.00
|
| Rate for Payer: United Healthcare All Payer |
$2,651.00
|
|
|
AFFIXUS GUIDWIR BALL NOSE 100C
|
Facility
|
OP
|
$3,012.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$903.75 |
| Max. Negotiated Rate |
$2,892.00 |
| Rate for Payer: Aetna Commercial |
$2,319.62
|
| Rate for Payer: Anthem Medicaid |
$1,036.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,349.75
|
| Rate for Payer: Cash Price |
$1,506.25
|
| Rate for Payer: Cigna Commercial |
$2,500.38
|
| Rate for Payer: First Health Commercial |
$2,861.88
|
| Rate for Payer: Humana Commercial |
$2,560.62
|
| Rate for Payer: Humana KY Medicaid |
$1,036.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,046.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,470.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,223.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$903.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,056.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,651.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,259.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.62
|
| Rate for Payer: PHCS Commercial |
$2,892.00
|
| Rate for Payer: United Healthcare All Payer |
$2,651.00
|
|
|
AFLURIA PFS 24-25
|
Facility
|
IP
|
$120.25
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
25000020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$115.44 |
| Rate for Payer: Aetna Commercial |
$92.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.80
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cigna Commercial |
$99.81
|
| Rate for Payer: First Health Commercial |
$114.24
|
| Rate for Payer: Humana Commercial |
$102.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.82
|
| Rate for Payer: Ohio Health Group HMO |
$90.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.97
|
| Rate for Payer: PHCS Commercial |
$115.44
|
| Rate for Payer: United Healthcare All Payer |
$105.82
|
|
|
AFLURIA PFS 24-25
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
77000020
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
AFLURIA PFS 24-25
|
Facility
|
IP
|
$120.25
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
636T0244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$115.44 |
| Rate for Payer: Aetna Commercial |
$92.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.80
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cigna Commercial |
$99.81
|
| Rate for Payer: First Health Commercial |
$114.24
|
| Rate for Payer: Humana Commercial |
$102.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.82
|
| Rate for Payer: Ohio Health Group HMO |
$90.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.97
|
| Rate for Payer: PHCS Commercial |
$115.44
|
| Rate for Payer: United Healthcare All Payer |
$105.82
|
|
|
AFLURIA PFS 24-25
|
Professional
|
Both
|
$120.25
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$72.15 |
| Rate for Payer: Ambetter Exchange |
$22.35
|
| Rate for Payer: Anthem Medicaid |
$23.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.82
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Healthspan PPO |
$23.44
|
| Rate for Payer: Humana Medicaid |
$23.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$28.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.68
|
| Rate for Payer: Molina Healthcare Passport |
$23.22
|
| Rate for Payer: Multiplan PHCS |
$72.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.05
|
| Rate for Payer: UHCCP Medicaid |
$42.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.35
|
|
|
AFLURIA PFS 24-25
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
77000020
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem Medicaid |
$41.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Humana KY Medicaid |
$41.61
|
| Rate for Payer: Kentucky WC Medicaid |
$42.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
AFLURIA PFS 24-25
|
Facility
|
OP
|
$120.25
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
25000020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$115.44 |
| Rate for Payer: Aetna Commercial |
$92.59
|
| Rate for Payer: Anthem Medicaid |
$41.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.80
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cigna Commercial |
$99.81
|
| Rate for Payer: First Health Commercial |
$114.24
|
| Rate for Payer: Humana Commercial |
$102.21
|
| Rate for Payer: Humana KY Medicaid |
$41.35
|
| Rate for Payer: Kentucky WC Medicaid |
$41.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.82
|
| Rate for Payer: Ohio Health Group HMO |
$90.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.97
|
| Rate for Payer: PHCS Commercial |
$115.44
|
| Rate for Payer: United Healthcare All Payer |
$105.82
|
|
