|
GUIDE CATH. IM 5F
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
GUIDE CATH JR 3.5 8FR
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
GUIDE CATH JR 3.5 8FR
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
GUIDE CAT JL 4.0 8FR
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
GUIDE CAT JL 4.0 8FR
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
GUIDELINER 5.5FR
|
Facility
|
OP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem Medicaid |
$1,207.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Humana KY Medicaid |
$1,207.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,220.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,232.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
GUIDELINER 5.5FR
|
Facility
|
IP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
GUIDELINER CATH 6FR
|
Facility
|
IP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
GUIDELINER CATH 6FR
|
Facility
|
OP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem Medicaid |
$1,207.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Humana KY Medicaid |
$1,207.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,220.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,232.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
GUIDELINER CATH 7FR
|
Facility
|
OP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem Medicaid |
$1,207.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Humana KY Medicaid |
$1,207.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,220.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,232.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
GUIDELINER CATH 7FR
|
Facility
|
IP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
GUIDE PIN TIP THRD 3.2*343MM
|
Facility
|
IP
|
$1,899.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.94 |
| Max. Negotiated Rate |
$1,823.52 |
| Rate for Payer: Aetna Commercial |
$1,462.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.61
|
| Rate for Payer: Cash Price |
$949.75
|
| Rate for Payer: Cigna Commercial |
$1,576.58
|
| Rate for Payer: First Health Commercial |
$1,804.52
|
| Rate for Payer: Humana Commercial |
$1,614.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,401.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,671.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.84
|
| Rate for Payer: PHCS Commercial |
$1,823.52
|
| Rate for Payer: United Healthcare All Payer |
$1,671.56
|
|
|
GUIDE PIN TIP THRD 3.2*343MM
|
Facility
|
OP
|
$1,899.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.94 |
| Max. Negotiated Rate |
$1,823.52 |
| Rate for Payer: Aetna Commercial |
$1,462.62
|
| Rate for Payer: Anthem Medicaid |
$653.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.61
|
| Rate for Payer: Cash Price |
$949.75
|
| Rate for Payer: Cigna Commercial |
$1,576.58
|
| Rate for Payer: First Health Commercial |
$1,804.52
|
| Rate for Payer: Humana Commercial |
$1,614.58
|
| Rate for Payer: Humana KY Medicaid |
$653.24
|
| Rate for Payer: Kentucky WC Medicaid |
$659.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,401.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,671.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.84
|
| Rate for Payer: PHCS Commercial |
$1,823.52
|
| Rate for Payer: United Healthcare All Payer |
$1,671.56
|
|
|
GUIDE PIN TIP THREADED 279.4
|
Facility
|
OP
|
$543.56
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.66 |
| Max. Negotiated Rate |
$521.82 |
| Rate for Payer: Aetna Commercial |
$418.54
|
| Rate for Payer: Anthem Medicaid |
$186.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.98
|
| Rate for Payer: Cash Price |
$271.78
|
| Rate for Payer: Cigna Commercial |
$451.15
|
| Rate for Payer: First Health Commercial |
$516.38
|
| Rate for Payer: Humana Commercial |
$462.03
|
| Rate for Payer: Humana KY Medicaid |
$186.93
|
| Rate for Payer: Kentucky WC Medicaid |
$188.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$401.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$478.33
|
| Rate for Payer: Ohio Health Group HMO |
$407.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.50
|
| Rate for Payer: PHCS Commercial |
$521.82
|
| Rate for Payer: United Healthcare All Payer |
$478.33
|
|
|
GUIDE PIN TIP THREADED 279.4
|
Facility
|
IP
|
$543.56
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.66 |
| Max. Negotiated Rate |
$521.82 |
| Rate for Payer: Aetna Commercial |
$418.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.98
|
| Rate for Payer: Cash Price |
$271.78
|
| Rate for Payer: Cigna Commercial |
$451.15
|
| Rate for Payer: First Health Commercial |
$516.38
|
| Rate for Payer: Humana Commercial |
$462.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$401.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$478.33
|
| Rate for Payer: Ohio Health Group HMO |
$407.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.50
|
| Rate for Payer: PHCS Commercial |
$521.82
|
| Rate for Payer: United Healthcare All Payer |
$478.33
|
|
|
GUIDE ROD GRADBALL TIP 2.0*600
|
Facility
|
OP
|
$1,784.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.04 |
| Max. Negotiated Rate |
$1,713.51 |
| Rate for Payer: Aetna Commercial |
$1,374.38
|
| Rate for Payer: Anthem Medicaid |
$613.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,392.23
|
| Rate for Payer: Cash Price |
$892.46
|
| Rate for Payer: Cigna Commercial |
$1,481.48
|
| Rate for Payer: First Health Commercial |
$1,695.66
|
| Rate for Payer: Humana Commercial |
$1,517.17
|
| Rate for Payer: Humana KY Medicaid |
$613.83
|
| Rate for Payer: Kentucky WC Medicaid |
$620.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,463.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,317.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$626.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,570.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.32
|
| Rate for Payer: PHCS Commercial |
$1,713.51
|
| Rate for Payer: United Healthcare All Payer |
$1,570.72
|
|
|
GUIDE ROD GRADBALL TIP 2.0*600
|
Facility
|
IP
|
$1,784.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.04 |
| Max. Negotiated Rate |
$1,713.51 |
| Rate for Payer: Aetna Commercial |
$1,374.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,392.23
|
| Rate for Payer: Cash Price |
$892.46
|
| Rate for Payer: Cigna Commercial |
$1,481.48
|
| Rate for Payer: First Health Commercial |
$1,695.66
|
| Rate for Payer: Humana Commercial |
$1,517.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,463.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,317.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,570.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.32
|
| Rate for Payer: PHCS Commercial |
$1,713.51
|
| Rate for Payer: United Healthcare All Payer |
$1,570.72
|
|
|
GUIDE SHEATH KIT K-401
|
Facility
|
IP
|
$3,145.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.85 |
| Max. Negotiated Rate |
$3,019.20 |
| Rate for Payer: Aetna Commercial |
$2,421.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,453.10
|
| Rate for Payer: Cash Price |
$1,572.50
|
| Rate for Payer: Cigna Commercial |
$2,610.35
|
| Rate for Payer: First Health Commercial |
$2,987.75
|
| Rate for Payer: Humana Commercial |
$2,673.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,578.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,321.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$943.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,767.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,358.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$974.95
|
| Rate for Payer: PHCS Commercial |
$3,019.20
|
| Rate for Payer: United Healthcare All Payer |
$2,767.60
|
|
|
GUIDE SHEATH KIT K-401
|
Facility
|
OP
|
$3,145.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.85 |
| Max. Negotiated Rate |
$3,019.20 |
| Rate for Payer: Aetna Commercial |
$2,421.65
|
| Rate for Payer: Anthem Medicaid |
$1,081.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,453.10
|
| Rate for Payer: Cash Price |
$1,572.50
|
| Rate for Payer: Cigna Commercial |
$2,610.35
|
| Rate for Payer: First Health Commercial |
$2,987.75
|
| Rate for Payer: Humana Commercial |
$2,673.25
|
| Rate for Payer: Humana KY Medicaid |
$1,081.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,092.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,578.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,321.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$943.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,103.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,767.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,358.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$974.95
|
| Rate for Payer: PHCS Commercial |
$3,019.20
|
| Rate for Payer: United Healthcare All Payer |
$2,767.60
|
|
|
GUIDE SHEATH KIT K-402
|
Facility
|
OP
|
$1,755.58
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$1,685.36 |
| Rate for Payer: Aetna Commercial |
$1,351.80
|
| Rate for Payer: Anthem Medicaid |
$603.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.35
|
| Rate for Payer: Cash Price |
$877.79
|
| Rate for Payer: Cigna Commercial |
$1,457.13
|
| Rate for Payer: First Health Commercial |
$1,667.80
|
| Rate for Payer: Humana Commercial |
$1,492.24
|
| Rate for Payer: Humana KY Medicaid |
$603.74
|
| Rate for Payer: Kentucky WC Medicaid |
$609.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$615.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,544.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,316.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.23
|
| Rate for Payer: PHCS Commercial |
$1,685.36
|
| Rate for Payer: United Healthcare All Payer |
$1,544.91
|
|
|
GUIDE SHEATH KIT K-402
|
Facility
|
IP
|
$1,755.58
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$1,685.36 |
| Rate for Payer: Aetna Commercial |
$1,351.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.35
|
| Rate for Payer: Cash Price |
$877.79
|
| Rate for Payer: Cigna Commercial |
$1,457.13
|
| Rate for Payer: First Health Commercial |
$1,667.80
|
| Rate for Payer: Humana Commercial |
$1,492.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,544.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,316.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.23
|
| Rate for Payer: PHCS Commercial |
$1,685.36
|
| Rate for Payer: United Healthcare All Payer |
$1,544.91
|
|
|
GUIDE SPRING WIRE DUOFLEX
|
Facility
|
OP
|
$445.34
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.89 |
| Max. Negotiated Rate |
$427.53 |
| Rate for Payer: Aetna Commercial |
$342.91
|
| Rate for Payer: Anthem Medicaid |
$153.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.37
|
| Rate for Payer: Cash Price |
$222.67
|
| Rate for Payer: Cigna Commercial |
$369.63
|
| Rate for Payer: First Health Commercial |
$423.07
|
| Rate for Payer: Humana Commercial |
$378.54
|
| Rate for Payer: Humana KY Medicaid |
$153.15
|
| Rate for Payer: Kentucky WC Medicaid |
$154.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$328.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$391.90
|
| Rate for Payer: Ohio Health Group HMO |
$334.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.06
|
| Rate for Payer: PHCS Commercial |
$427.53
|
| Rate for Payer: United Healthcare All Payer |
$391.90
|
|
|
GUIDE SPRING WIRE DUOFLEX
|
Facility
|
IP
|
$445.34
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.89 |
| Max. Negotiated Rate |
$427.53 |
| Rate for Payer: Aetna Commercial |
$342.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.37
|
| Rate for Payer: Cash Price |
$222.67
|
| Rate for Payer: Cigna Commercial |
$369.63
|
| Rate for Payer: First Health Commercial |
$423.07
|
| Rate for Payer: Humana Commercial |
$378.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$328.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$391.90
|
| Rate for Payer: Ohio Health Group HMO |
$334.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.06
|
| Rate for Payer: PHCS Commercial |
$427.53
|
| Rate for Payer: United Healthcare All Payer |
$391.90
|
|
|
GUIDEWIRE
|
Facility
|
OP
|
$1,717.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Anthem Medicaid |
$590.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Humana KY Medicaid |
$590.65
|
| Rate for Payer: Kentucky WC Medicaid |
$596.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$602.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
|
GUIDEWIRE
|
Facility
|
IP
|
$1,717.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
