|
GLENOSPHERE STANDARD 36MM
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
GLENOSPHERE STANDARD 36MM
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
GLIDECATH 4F ANGLED 100CM
|
Facility
|
OP
|
$1,991.84
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.55 |
| Max. Negotiated Rate |
$1,912.17 |
| Rate for Payer: Aetna Commercial |
$1,533.72
|
| Rate for Payer: Anthem Medicaid |
$684.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,553.64
|
| Rate for Payer: Cash Price |
$995.92
|
| Rate for Payer: Cigna Commercial |
$1,653.23
|
| Rate for Payer: First Health Commercial |
$1,892.25
|
| Rate for Payer: Humana Commercial |
$1,693.06
|
| Rate for Payer: Humana KY Medicaid |
$684.99
|
| Rate for Payer: Kentucky WC Medicaid |
$691.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,633.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,469.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$698.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,752.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,493.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,732.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,374.37
|
| Rate for Payer: PHCS Commercial |
$1,912.17
|
| Rate for Payer: United Healthcare All Payer |
$1,752.82
|
|
|
GLIDECATH 4F ANGLED 100CM
|
Facility
|
IP
|
$1,991.84
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.55 |
| Max. Negotiated Rate |
$1,912.17 |
| Rate for Payer: Aetna Commercial |
$1,533.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,553.64
|
| Rate for Payer: Cash Price |
$995.92
|
| Rate for Payer: Cigna Commercial |
$1,653.23
|
| Rate for Payer: First Health Commercial |
$1,892.25
|
| Rate for Payer: Humana Commercial |
$1,693.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,633.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,469.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,752.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,493.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,732.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,374.37
|
| Rate for Payer: PHCS Commercial |
$1,912.17
|
| Rate for Payer: United Healthcare All Payer |
$1,752.82
|
|
|
GLIDECATH 4FR 65CM ANGLED
|
Facility
|
OP
|
$842.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem Medicaid |
$289.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Humana KY Medicaid |
$289.82
|
| Rate for Payer: Kentucky WC Medicaid |
$292.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
GLIDECATH 4FR 65CM ANGLED
|
Facility
|
IP
|
$842.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
GLIDECATH 4FR MULTIPURPOS 100C
|
Facility
|
OP
|
$842.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem Medicaid |
$289.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Humana KY Medicaid |
$289.82
|
| Rate for Payer: Kentucky WC Medicaid |
$292.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
GLIDECATH 4FR MULTIPURPOS 100C
|
Facility
|
IP
|
$842.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
GLIDECATH 4FR ST 120CM
|
Facility
|
OP
|
$842.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem Medicaid |
$289.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Humana KY Medicaid |
$289.82
|
| Rate for Payer: Kentucky WC Medicaid |
$292.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
GLIDECATH 4FR ST 120CM
|
Facility
|
IP
|
$842.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
GLIDECATH 4F STRAIGHT 100CM
|
Facility
|
IP
|
$2,222.45
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.74 |
| Max. Negotiated Rate |
$2,133.55 |
| Rate for Payer: Aetna Commercial |
$1,711.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,733.51
|
| Rate for Payer: Cash Price |
$1,111.22
|
| Rate for Payer: Cigna Commercial |
$1,844.63
|
| Rate for Payer: First Health Commercial |
$2,111.33
|
| Rate for Payer: Humana Commercial |
$1,889.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,822.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,640.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,955.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,666.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,933.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,533.49
|
| Rate for Payer: PHCS Commercial |
$2,133.55
|
| Rate for Payer: United Healthcare All Payer |
$1,955.76
|
|
|
GLIDECATH 4F STRAIGHT 100CM
|
Facility
|
OP
|
$2,222.45
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.74 |
| Max. Negotiated Rate |
$2,133.55 |
| Rate for Payer: Aetna Commercial |
$1,711.29
|
| Rate for Payer: Anthem Medicaid |
$764.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,733.51
|
| Rate for Payer: Cash Price |
$1,111.22
|
| Rate for Payer: Cigna Commercial |
$1,844.63
|
| Rate for Payer: First Health Commercial |
$2,111.33
|
| Rate for Payer: Humana Commercial |
$1,889.08
|
| Rate for Payer: Humana KY Medicaid |
$764.30
|
| Rate for Payer: Kentucky WC Medicaid |
$772.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,822.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,640.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$779.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,955.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,666.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,933.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,533.49
|
| Rate for Payer: PHCS Commercial |
$2,133.55
|
| Rate for Payer: United Healthcare All Payer |
$1,955.76
|
|
|
GLIDECATH 5F MULTIPURPOSE 100C
|
Facility
|
OP
|
$3,331.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$999.38 |
| Max. Negotiated Rate |
$3,198.00 |
| Rate for Payer: Aetna Commercial |
$2,565.06
|
| Rate for Payer: Anthem Medicaid |
$1,145.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,598.38
|
| Rate for Payer: Cash Price |
$1,665.62
|
| Rate for Payer: Cigna Commercial |
$2,764.94
|
| Rate for Payer: First Health Commercial |
$3,164.69
|
| Rate for Payer: Humana Commercial |
$2,831.56
|
| Rate for Payer: Humana KY Medicaid |
$1,145.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,157.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,731.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,458.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$999.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,168.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,931.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,498.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,898.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.56
|
| Rate for Payer: PHCS Commercial |
$3,198.00
|
| Rate for Payer: United Healthcare All Payer |
$2,931.50
|
|
|
GLIDECATH 5F MULTIPURPOSE 100C
|
Facility
|
IP
|
$3,331.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$999.38 |
| Max. Negotiated Rate |
$3,198.00 |
| Rate for Payer: Aetna Commercial |
$2,565.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,598.38
|
| Rate for Payer: Cash Price |
$1,665.62
|
| Rate for Payer: Cigna Commercial |
$2,764.94
|
| Rate for Payer: First Health Commercial |
$3,164.69
|
| Rate for Payer: Humana Commercial |
$2,831.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,731.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,458.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$999.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,931.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,498.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,898.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.56
|
| Rate for Payer: PHCS Commercial |
$3,198.00
|
| Rate for Payer: United Healthcare All Payer |
$2,931.50
|
|
|
GLIDECATH 5FR AT 100CM
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
GLIDECATH 5FR AT 100CM
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem Medicaid |
$414.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Humana KY Medicaid |
$414.40
|
| Rate for Payer: Kentucky WC Medicaid |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
GLIDECATH 5FR AT 65CM ANGLED
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem Medicaid |
$414.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Humana KY Medicaid |
$414.40
|
| Rate for Payer: Kentucky WC Medicaid |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
GLIDECATH 5FR AT 65CM ANGLED
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
GLIDECATH 5FR JB2 100CM
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
GLIDECATH 5FR JB2 100CM
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem Medicaid |
$414.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Humana KY Medicaid |
$414.40
|
| Rate for Payer: Kentucky WC Medicaid |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
GLIDECATH 5FR SIM 2 100CM
|
Facility
|
IP
|
$842.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
GLIDECATH 5FR SIM 2 100CM
|
Facility
|
OP
|
$842.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem Medicaid |
$289.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Humana KY Medicaid |
$289.82
|
| Rate for Payer: Kentucky WC Medicaid |
$292.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
GLIDECATH 5FR ST 100CM
|
Facility
|
IP
|
$842.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
GLIDECATH 5FR ST 100CM
|
Facility
|
OP
|
$842.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem Medicaid |
$289.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Humana KY Medicaid |
$289.82
|
| Rate for Payer: Kentucky WC Medicaid |
$292.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
GLIDECATH 5FR ST 65CM
|
Facility
|
IP
|
$842.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
