|
DILATOR 16/18F 45CM
|
Facility
|
IP
|
$2,170.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$651.06 |
| Max. Negotiated Rate |
$2,083.39 |
| Rate for Payer: Aetna Commercial |
$1,671.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,692.76
|
| Rate for Payer: Cash Price |
$1,085.10
|
| Rate for Payer: Cigna Commercial |
$1,801.27
|
| Rate for Payer: First Health Commercial |
$2,061.69
|
| Rate for Payer: Humana Commercial |
$1,844.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,779.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,601.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,909.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,627.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,736.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,888.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,497.44
|
| Rate for Payer: PHCS Commercial |
$2,083.39
|
| Rate for Payer: United Healthcare All Payer |
$1,909.78
|
|
|
DILATOR 16/18F 45CM
|
Facility
|
OP
|
$2,170.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$651.06 |
| Max. Negotiated Rate |
$2,083.39 |
| Rate for Payer: Aetna Commercial |
$1,671.05
|
| Rate for Payer: Anthem Medicaid |
$746.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,692.76
|
| Rate for Payer: Cash Price |
$1,085.10
|
| Rate for Payer: Cigna Commercial |
$1,801.27
|
| Rate for Payer: First Health Commercial |
$2,061.69
|
| Rate for Payer: Humana Commercial |
$1,844.67
|
| Rate for Payer: Humana KY Medicaid |
$746.33
|
| Rate for Payer: Kentucky WC Medicaid |
$753.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,779.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,601.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$761.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,909.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,627.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,736.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,888.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,497.44
|
| Rate for Payer: PHCS Commercial |
$2,083.39
|
| Rate for Payer: United Healthcare All Payer |
$1,909.78
|
|
|
DILATOR 5F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 5F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 6F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 6F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 6FR .038
|
Facility
|
OP
|
$1,115.30
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.59 |
| Max. Negotiated Rate |
$1,070.69 |
| Rate for Payer: Aetna Commercial |
$858.78
|
| Rate for Payer: Anthem Medicaid |
$383.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.93
|
| Rate for Payer: Cash Price |
$557.65
|
| Rate for Payer: Cigna Commercial |
$925.70
|
| Rate for Payer: First Health Commercial |
$1,059.54
|
| Rate for Payer: Humana Commercial |
$948.00
|
| Rate for Payer: Humana KY Medicaid |
$383.55
|
| Rate for Payer: Kentucky WC Medicaid |
$387.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$823.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.46
|
| Rate for Payer: Ohio Health Group HMO |
$836.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$769.56
|
| Rate for Payer: PHCS Commercial |
$1,070.69
|
| Rate for Payer: United Healthcare All Payer |
$981.46
|
|
|
DILATOR 6FR .038
|
Facility
|
IP
|
$1,115.30
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.59 |
| Max. Negotiated Rate |
$1,070.69 |
| Rate for Payer: Aetna Commercial |
$858.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.93
|
| Rate for Payer: Cash Price |
$557.65
|
| Rate for Payer: Cigna Commercial |
$925.70
|
| Rate for Payer: First Health Commercial |
$1,059.54
|
| Rate for Payer: Humana Commercial |
$948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$823.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.46
|
| Rate for Payer: Ohio Health Group HMO |
$836.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$769.56
|
| Rate for Payer: PHCS Commercial |
$1,070.69
|
| Rate for Payer: United Healthcare All Payer |
$981.46
|
|
|
DILATOR 7F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 7F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 8F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR 8F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DILATOR BALLOON 225-136
|
Facility
|
OP
|
$3,016.55
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$904.97 |
| Max. Negotiated Rate |
$2,895.89 |
| Rate for Payer: Aetna Commercial |
$2,322.74
|
| Rate for Payer: Anthem Medicaid |
$1,037.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,352.91
|
| Rate for Payer: Cash Price |
$1,508.28
|
| Rate for Payer: Cigna Commercial |
$2,503.74
|
| Rate for Payer: First Health Commercial |
$2,865.72
|
| Rate for Payer: Humana Commercial |
$2,564.07
|
| Rate for Payer: Humana KY Medicaid |
$1,037.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,047.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,473.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,226.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$904.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,058.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,654.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,262.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,413.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,624.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,081.42
|
| Rate for Payer: PHCS Commercial |
$2,895.89
|
| Rate for Payer: United Healthcare All Payer |
$2,654.56
|
|
|
DILATOR BALLOON 225-136
|
Facility
|
IP
|
$3,016.55
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$904.97 |
| Max. Negotiated Rate |
$2,895.89 |
| Rate for Payer: Aetna Commercial |
$2,322.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,352.91
|
| Rate for Payer: Cash Price |
$1,508.28
|
| Rate for Payer: Cigna Commercial |
$2,503.74
|
| Rate for Payer: First Health Commercial |
$2,865.72
|
| Rate for Payer: Humana Commercial |
$2,564.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,473.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,226.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$904.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,654.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,262.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,413.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,624.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,081.42
|
| Rate for Payer: PHCS Commercial |
$2,895.89
|
| Rate for Payer: United Healthcare All Payer |
$2,654.56
|
|
|
DILATOR BALLOON CRE 12-15MM
|
Facility
|
IP
|
$1,920.57
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.17 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,478.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,498.04
|
| Rate for Payer: Cash Price |
$960.29
|
| Rate for Payer: Cigna Commercial |
$1,594.07
|
| Rate for Payer: First Health Commercial |
$1,824.54
|
| Rate for Payer: Humana Commercial |
$1,632.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$1,843.75
|
| Rate for Payer: United Healthcare All Payer |
$1,690.10
|
|
|
DILATOR BALLOON CRE 12-15MM
|
Facility
|
OP
|
$1,920.57
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.17 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,478.84
|
| Rate for Payer: Anthem Medicaid |
$660.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,498.04
|
| Rate for Payer: Cash Price |
$960.29
|
| Rate for Payer: Cigna Commercial |
$1,594.07
|
| Rate for Payer: First Health Commercial |
$1,824.54
|
| Rate for Payer: Humana Commercial |
$1,632.48
|
| Rate for Payer: Humana KY Medicaid |
$660.48
|
| Rate for Payer: Kentucky WC Medicaid |
$667.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$1,843.75
|
| Rate for Payer: United Healthcare All Payer |
$1,690.10
|
|
|
DILATOR BALLOON CRE 15-18MM
|
Facility
|
IP
|
$1,920.57
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.17 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,478.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,498.04
|
| Rate for Payer: Cash Price |
$960.29
|
| Rate for Payer: Cigna Commercial |
$1,594.07
|
| Rate for Payer: First Health Commercial |
$1,824.54
|
| Rate for Payer: Humana Commercial |
$1,632.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$1,843.75
|
| Rate for Payer: United Healthcare All Payer |
$1,690.10
|
|
|
DILATOR BALLOON CRE 15-18MM
|
Facility
|
OP
|
$1,920.57
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.17 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,478.84
|
| Rate for Payer: Anthem Medicaid |
$660.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,498.04
|
| Rate for Payer: Cash Price |
$960.29
|
| Rate for Payer: Cigna Commercial |
$1,594.07
|
| Rate for Payer: First Health Commercial |
$1,824.54
|
| Rate for Payer: Humana Commercial |
$1,632.48
|
| Rate for Payer: Humana KY Medicaid |
$660.48
|
| Rate for Payer: Kentucky WC Medicaid |
$667.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$1,843.75
|
| Rate for Payer: United Healthcare All Payer |
$1,690.10
|
|
|
DILATOR BALLOON CRE 18-20MM
|
Facility
|
IP
|
$1,920.57
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.17 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,478.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,498.04
|
| Rate for Payer: Cash Price |
$960.29
|
| Rate for Payer: Cigna Commercial |
$1,594.07
|
| Rate for Payer: First Health Commercial |
$1,824.54
|
| Rate for Payer: Humana Commercial |
$1,632.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$1,843.75
|
| Rate for Payer: United Healthcare All Payer |
$1,690.10
|
|
|
DILATOR BALLOON CRE 18-20MM
|
Facility
|
OP
|
$1,920.57
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.17 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,478.84
|
| Rate for Payer: Anthem Medicaid |
$660.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,498.04
|
| Rate for Payer: Cash Price |
$960.29
|
| Rate for Payer: Cigna Commercial |
$1,594.07
|
| Rate for Payer: First Health Commercial |
$1,824.54
|
| Rate for Payer: Humana Commercial |
$1,632.48
|
| Rate for Payer: Humana KY Medicaid |
$660.48
|
| Rate for Payer: Kentucky WC Medicaid |
$667.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$1,843.75
|
| Rate for Payer: United Healthcare All Payer |
$1,690.10
|
|
|
DILATOR COAXIAL 8/10
|
Facility
|
IP
|
$566.08
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.82 |
| Max. Negotiated Rate |
$543.44 |
| Rate for Payer: Aetna Commercial |
$435.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.54
|
| Rate for Payer: Cash Price |
$283.04
|
| Rate for Payer: Cigna Commercial |
$469.85
|
| Rate for Payer: First Health Commercial |
$537.78
|
| Rate for Payer: Humana Commercial |
$481.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.15
|
| Rate for Payer: Ohio Health Group HMO |
$424.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.60
|
| Rate for Payer: PHCS Commercial |
$543.44
|
| Rate for Payer: United Healthcare All Payer |
$498.15
|
|
|
DILATOR COAXIAL 8/10
|
Facility
|
OP
|
$566.08
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.82 |
| Max. Negotiated Rate |
$543.44 |
| Rate for Payer: Aetna Commercial |
$435.88
|
| Rate for Payer: Anthem Medicaid |
$194.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.54
|
| Rate for Payer: Cash Price |
$283.04
|
| Rate for Payer: Cigna Commercial |
$469.85
|
| Rate for Payer: First Health Commercial |
$537.78
|
| Rate for Payer: Humana Commercial |
$481.17
|
| Rate for Payer: Humana KY Medicaid |
$194.67
|
| Rate for Payer: Kentucky WC Medicaid |
$196.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.15
|
| Rate for Payer: Ohio Health Group HMO |
$424.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.60
|
| Rate for Payer: PHCS Commercial |
$543.44
|
| Rate for Payer: United Healthcare All Payer |
$498.15
|
|
|
DILATOR RENAL AMPLATZ 10*3
|
Facility
|
OP
|
$793.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.05 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$611.00
|
| Rate for Payer: Anthem Medicaid |
$272.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$618.93
|
| Rate for Payer: Cash Price |
$396.75
|
| Rate for Payer: Cigna Commercial |
$658.61
|
| Rate for Payer: First Health Commercial |
$753.83
|
| Rate for Payer: Humana Commercial |
$674.48
|
| Rate for Payer: Humana KY Medicaid |
$272.88
|
| Rate for Payer: Kentucky WC Medicaid |
$275.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.28
|
| Rate for Payer: Ohio Health Group HMO |
$595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.51
|
| Rate for Payer: PHCS Commercial |
$761.76
|
| Rate for Payer: United Healthcare All Payer |
$698.28
|
|
|
DILATOR RENAL AMPLATZ 10*3
|
Facility
|
IP
|
$793.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.05 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$618.93
|
| Rate for Payer: Cash Price |
$396.75
|
| Rate for Payer: Cigna Commercial |
$658.61
|
| Rate for Payer: First Health Commercial |
$753.83
|
| Rate for Payer: Humana Commercial |
$674.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.28
|
| Rate for Payer: Ohio Health Group HMO |
$595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.51
|
| Rate for Payer: PHCS Commercial |
$761.76
|
| Rate for Payer: United Healthcare All Payer |
$698.28
|
|
|
DILATOR RENAL AMPLATZ 14*8
|
Facility
|
IP
|
$793.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.05 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$618.93
|
| Rate for Payer: Cash Price |
$396.75
|
| Rate for Payer: Cigna Commercial |
$658.61
|
| Rate for Payer: First Health Commercial |
$753.83
|
| Rate for Payer: Humana Commercial |
$674.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.28
|
| Rate for Payer: Ohio Health Group HMO |
$595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.51
|
| Rate for Payer: PHCS Commercial |
$761.76
|
| Rate for Payer: United Healthcare All Payer |
$698.28
|
|
