|
GLENOSPHERE S/36+2.5INF
|
Facility
|
IP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
GLENOSPHERE S/36+2.5INF
|
Facility
|
OP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem Medicaid |
$4,021.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Humana KY Medicaid |
$4,021.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
GLENOSPHERE S/36+4LAT
|
Facility
|
OP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem Medicaid |
$4,021.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Humana KY Medicaid |
$4,021.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
GLENOSPHERE S/36+4LAT
|
Facility
|
IP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
GLENOSPHERE S/39+2.5INF
|
Facility
|
OP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem Medicaid |
$4,021.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Humana KY Medicaid |
$4,021.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
GLENOSPHERE S/39+2.5INF
|
Facility
|
IP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
GLENOSPHERE STANDARD 36MM
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
GLENOSPHERE STANDARD 36MM
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
GLIDECATH 4F ANGLED 100CM
|
Facility
|
IP
|
$2,199.62
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.95 |
| Max. Negotiated Rate |
$2,111.64 |
| Rate for Payer: Aetna Commercial |
$1,693.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,715.70
|
| Rate for Payer: Cash Price |
$1,099.81
|
| Rate for Payer: Cigna Commercial |
$1,825.68
|
| Rate for Payer: First Health Commercial |
$2,089.64
|
| Rate for Payer: Humana Commercial |
$1,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,803.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,935.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,649.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$681.88
|
| Rate for Payer: PHCS Commercial |
$2,111.64
|
| Rate for Payer: United Healthcare All Payer |
$1,935.67
|
|
|
GLIDECATH 4F ANGLED 100CM
|
Facility
|
OP
|
$2,199.62
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.95 |
| Max. Negotiated Rate |
$2,111.64 |
| Rate for Payer: Aetna Commercial |
$1,693.71
|
| Rate for Payer: Anthem Medicaid |
$756.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,715.70
|
| Rate for Payer: Cash Price |
$1,099.81
|
| Rate for Payer: Cigna Commercial |
$1,825.68
|
| Rate for Payer: First Health Commercial |
$2,089.64
|
| Rate for Payer: Humana Commercial |
$1,869.68
|
| Rate for Payer: Humana KY Medicaid |
$756.45
|
| Rate for Payer: Kentucky WC Medicaid |
$764.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,803.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,935.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,649.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$681.88
|
| Rate for Payer: PHCS Commercial |
$2,111.64
|
| Rate for Payer: United Healthcare All Payer |
$1,935.67
|
|
|
GLIDECATH 4FR 65CM ANGLED
|
Facility
|
IP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 4FR 65CM ANGLED
|
Facility
|
OP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem Medicaid |
$281.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Humana KY Medicaid |
$281.48
|
| Rate for Payer: Kentucky WC Medicaid |
$284.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 4FR MULTIPURPOS 100C
|
Facility
|
IP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 4FR MULTIPURPOS 100C
|
Facility
|
OP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem Medicaid |
$281.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Humana KY Medicaid |
$281.48
|
| Rate for Payer: Kentucky WC Medicaid |
$284.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 4FR ST 120CM
|
Facility
|
OP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem Medicaid |
$281.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Humana KY Medicaid |
$281.48
|
| Rate for Payer: Kentucky WC Medicaid |
$284.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 4FR ST 120CM
|
Facility
|
IP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 4F STRAIGHT 100CM
|
Facility
|
OP
|
$2,199.62
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.95 |
| Max. Negotiated Rate |
$2,111.64 |
| Rate for Payer: Aetna Commercial |
$1,693.71
|
| Rate for Payer: Anthem Medicaid |
$756.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,715.70
|
| Rate for Payer: Cash Price |
$1,099.81
|
| Rate for Payer: Cigna Commercial |
$1,825.68
|
| Rate for Payer: First Health Commercial |
$2,089.64
|
| Rate for Payer: Humana Commercial |
$1,869.68
|
| Rate for Payer: Humana KY Medicaid |
$756.45
|
| Rate for Payer: Kentucky WC Medicaid |
$764.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,803.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,935.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,649.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$681.88
|
| Rate for Payer: PHCS Commercial |
$2,111.64
|
| Rate for Payer: United Healthcare All Payer |
$1,935.67
|
|
|
GLIDECATH 4F STRAIGHT 100CM
|
Facility
|
IP
|
$2,199.62
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.95 |
| Max. Negotiated Rate |
$2,111.64 |
| Rate for Payer: Aetna Commercial |
$1,693.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,715.70
|
| Rate for Payer: Cash Price |
$1,099.81
|
| Rate for Payer: Cigna Commercial |
$1,825.68
|
| Rate for Payer: First Health Commercial |
$2,089.64
|
| Rate for Payer: Humana Commercial |
$1,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,803.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,935.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,649.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$681.88
|
| Rate for Payer: PHCS Commercial |
$2,111.64
|
| Rate for Payer: United Healthcare All Payer |
$1,935.67
|
|
|
GLIDECATH 5FR AT 100CM
|
Facility
|
IP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 5FR AT 100CM
|
Facility
|
OP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem Medicaid |
$281.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Humana KY Medicaid |
$281.48
|
| Rate for Payer: Kentucky WC Medicaid |
$284.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 5FR AT 65CM ANGLED
|
Facility
|
IP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 5FR AT 65CM ANGLED
|
Facility
|
OP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem Medicaid |
$281.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Humana KY Medicaid |
$281.48
|
| Rate for Payer: Kentucky WC Medicaid |
$284.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 5FR JB2 100CM
|
Facility
|
OP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem Medicaid |
$281.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Humana KY Medicaid |
$281.48
|
| Rate for Payer: Kentucky WC Medicaid |
$284.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 5FR JB2 100CM
|
Facility
|
IP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
|
GLIDECATH 5FR SIM 2 100CM
|
Facility
|
IP
|
$818.48
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$785.74 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.41
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cigna Commercial |
$679.34
|
| Rate for Payer: First Health Commercial |
$777.56
|
| Rate for Payer: Humana Commercial |
$695.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$720.26
|
| Rate for Payer: Ohio Health Group HMO |
$613.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.73
|
| Rate for Payer: PHCS Commercial |
$785.74
|
| Rate for Payer: United Healthcare All Payer |
$720.26
|
|
