|
GLIDECATH 5FR SIM 2 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 ST 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 ST 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 ST 65CM
|
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 ST 65CM
|
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 ANGLED 4FR 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 ANGLED 4FR 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 J-TIP CURVE 65CM
|
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 J-TIP CURVE 65CM
|
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 SIM 1 100CM 5FR
|
Facility
|
OP
|
$819.38
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.52 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Aetna Commercial |
$630.92
|
| Rate for Payer: Anthem Medicaid |
$281.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.12
|
| Rate for Payer: Cash Price |
$409.69
|
| Rate for Payer: Cigna Commercial |
$680.09
|
| Rate for Payer: First Health Commercial |
$778.41
|
| Rate for Payer: Humana Commercial |
$696.47
|
| Rate for Payer: Humana KY Medicaid |
$281.78
|
| Rate for Payer: Kentucky WC Medicaid |
$284.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$721.05
|
| Rate for Payer: Ohio Health Group HMO |
$614.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$254.01
|
| Rate for Payer: PHCS Commercial |
$786.60
|
| Rate for Payer: United Healthcare All Payer |
$721.05
|
|
|
GLIDECATH SIM 1 100CM 5FR
|
Facility
|
IP
|
$819.38
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.52 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Aetna Commercial |
$630.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.12
|
| Rate for Payer: Cash Price |
$409.69
|
| Rate for Payer: Cigna Commercial |
$680.09
|
| Rate for Payer: First Health Commercial |
$778.41
|
| Rate for Payer: Humana Commercial |
$696.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$671.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$604.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$721.05
|
| Rate for Payer: Ohio Health Group HMO |
$614.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$254.01
|
| Rate for Payer: PHCS Commercial |
$786.60
|
| Rate for Payer: United Healthcare All Payer |
$721.05
|
|
|
GLIDECATH/SIMMONS
|
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/SIMMONS
|
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 ST 65CM 4FR
|
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 ST 65CM 4FR
|
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
|
|
|
GLIDER BALLOON 1.5*12
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
GLIDER BALLOON 1.5*12
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
GLIDER BALLOON 2.0*12
|
Facility
|
IP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
GLIDER BALLOON 2.0*12
|
Facility
|
OP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem Medicaid |
$1,111.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Humana KY Medicaid |
$1,111.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
GLIDER BALLOON 2.0*20
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
GLIDER BALLOON 2.0*20
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
GLIDER BALLOON 2.5*12
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
GLIDER BALLOON 2.5*12
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
GLIDER BALLOON 2.5*20
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
GLIDER BALLOON 2.5*20
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
