|
GLIDECATH 5FR ST 65CM
|
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 ANGLED 4FR 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 ANGLED 4FR 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 J-TIP CURVE 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
|
|
|
GLIDECATH J-TIP CURVE 65CM
|
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 SIM 1 100CM 5FR
|
Facility
|
OP
|
$843.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.12 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna Commercial |
$649.69
|
| Rate for Payer: Anthem Medicaid |
$290.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$658.12
|
| Rate for Payer: Cash Price |
$421.88
|
| Rate for Payer: Cigna Commercial |
$700.31
|
| Rate for Payer: First Health Commercial |
$801.56
|
| Rate for Payer: Humana Commercial |
$717.19
|
| Rate for Payer: Humana KY Medicaid |
$290.17
|
| Rate for Payer: Kentucky WC Medicaid |
$293.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$622.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$742.50
|
| Rate for Payer: Ohio Health Group HMO |
$632.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.19
|
| Rate for Payer: PHCS Commercial |
$810.00
|
| Rate for Payer: United Healthcare All Payer |
$742.50
|
|
|
GLIDECATH SIM 1 100CM 5FR
|
Facility
|
IP
|
$843.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.12 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna Commercial |
$649.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$658.12
|
| Rate for Payer: Cash Price |
$421.88
|
| Rate for Payer: Cigna Commercial |
$700.31
|
| Rate for Payer: First Health Commercial |
$801.56
|
| Rate for Payer: Humana Commercial |
$717.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$622.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$742.50
|
| Rate for Payer: Ohio Health Group HMO |
$632.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.19
|
| Rate for Payer: PHCS Commercial |
$810.00
|
| Rate for Payer: United Healthcare All Payer |
$742.50
|
|
|
GLIDECATH/SIMMONS
|
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/SIMMONS
|
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 ST 65CM 4FR
|
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 ST 65CM 4FR
|
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
|
|
|
GLIDER BALLOON 1.5*12
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
GLIDER BALLOON 1.5*12
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem Medicaid |
$1,139.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
GLIDER BALLOON 2.0*12
|
Facility
|
OP
|
$3,106.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.88 |
| Max. Negotiated Rate |
$2,982.00 |
| Rate for Payer: Aetna Commercial |
$2,391.81
|
| Rate for Payer: Anthem Medicaid |
$1,068.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,422.88
|
| Rate for Payer: Cash Price |
$1,553.12
|
| Rate for Payer: Cigna Commercial |
$2,578.19
|
| Rate for Payer: First Health Commercial |
$2,950.94
|
| Rate for Payer: Humana Commercial |
$2,640.31
|
| Rate for Payer: Humana KY Medicaid |
$1,068.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,079.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,547.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,292.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,089.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,733.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,143.31
|
| Rate for Payer: PHCS Commercial |
$2,982.00
|
| Rate for Payer: United Healthcare All Payer |
$2,733.50
|
|
|
GLIDER BALLOON 2.0*12
|
Facility
|
IP
|
$3,106.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.88 |
| Max. Negotiated Rate |
$2,982.00 |
| Rate for Payer: Aetna Commercial |
$2,391.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,422.88
|
| Rate for Payer: Cash Price |
$1,553.12
|
| Rate for Payer: Cigna Commercial |
$2,578.19
|
| Rate for Payer: First Health Commercial |
$2,950.94
|
| Rate for Payer: Humana Commercial |
$2,640.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,547.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,292.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,733.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,143.31
|
| Rate for Payer: PHCS Commercial |
$2,982.00
|
| Rate for Payer: United Healthcare All Payer |
$2,733.50
|
|
|
GLIDER BALLOON 2.0*20
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
GLIDER BALLOON 2.0*20
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem Medicaid |
$1,139.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
GLIDER BALLOON 2.5*12
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem Medicaid |
$1,139.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
GLIDER BALLOON 2.5*12
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
GLIDER BALLOON 2.5*20
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
GLIDER BALLOON 2.5*20
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem Medicaid |
$1,139.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
GLIDESHEATH SLENDER 7FR
|
Facility
|
IP
|
$1,830.10
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.03 |
| Max. Negotiated Rate |
$1,756.90 |
| Rate for Payer: Aetna Commercial |
$1,409.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.48
|
| Rate for Payer: Cash Price |
$915.05
|
| Rate for Payer: Cigna Commercial |
$1,518.98
|
| Rate for Payer: First Health Commercial |
$1,738.60
|
| Rate for Payer: Humana Commercial |
$1,555.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,464.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,262.77
|
| Rate for Payer: PHCS Commercial |
$1,756.90
|
| Rate for Payer: United Healthcare All Payer |
$1,610.49
|
|
|
GLIDESHEATH SLENDER 7FR
|
Facility
|
OP
|
$1,830.10
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.03 |
| Max. Negotiated Rate |
$1,756.90 |
| Rate for Payer: Aetna Commercial |
$1,409.18
|
| Rate for Payer: Anthem Medicaid |
$629.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.48
|
| Rate for Payer: Cash Price |
$915.05
|
| Rate for Payer: Cigna Commercial |
$1,518.98
|
| Rate for Payer: First Health Commercial |
$1,738.60
|
| Rate for Payer: Humana Commercial |
$1,555.59
|
| Rate for Payer: Humana KY Medicaid |
$629.37
|
| Rate for Payer: Kentucky WC Medicaid |
$635.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,464.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,262.77
|
| Rate for Payer: PHCS Commercial |
$1,756.90
|
| Rate for Payer: United Healthcare All Payer |
$1,610.49
|
|
|
GLIDEWIRE .035 260CM ANGLED
|
Facility
|
IP
|
$1,172.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,125.60 |
| Rate for Payer: Aetna Commercial |
$902.83
|
| Rate for Payer: Aetna Commercial |
$632.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$641.16
|
| Rate for Payer: Cash Price |
$586.25
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$973.17
|
| Rate for Payer: Cigna Commercial |
$682.26
|
| Rate for Payer: First Health Commercial |
$780.90
|
| Rate for Payer: First Health Commercial |
$1,113.88
|
| Rate for Payer: Humana Commercial |
$698.70
|
| Rate for Payer: Humana Commercial |
$996.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$961.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$674.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$865.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$606.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,031.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$723.36
|
| Rate for Payer: Ohio Health Group HMO |
$879.38
|
| Rate for Payer: Ohio Health Group HMO |
$616.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,020.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.02
|
| Rate for Payer: PHCS Commercial |
$1,125.60
|
| Rate for Payer: PHCS Commercial |
$789.12
|
| Rate for Payer: United Healthcare All Payer |
$1,031.80
|
| Rate for Payer: United Healthcare All Payer |
$723.36
|
|
|
GLIDEWIRE .035 260CM ANGLED
|
Facility
|
OP
|
$1,172.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,125.60 |
| Rate for Payer: Aetna Commercial |
$902.83
|
| Rate for Payer: Aetna Commercial |
$632.94
|
| Rate for Payer: Anthem Medicaid |
$403.22
|
| Rate for Payer: Anthem Medicaid |
$282.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$641.16
|
| Rate for Payer: Cash Price |
$586.25
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$682.26
|
| Rate for Payer: Cigna Commercial |
$973.17
|
| Rate for Payer: First Health Commercial |
$780.90
|
| Rate for Payer: First Health Commercial |
$1,113.88
|
| Rate for Payer: Humana Commercial |
$996.62
|
| Rate for Payer: Humana Commercial |
$698.70
|
| Rate for Payer: Humana KY Medicaid |
$403.22
|
| Rate for Payer: Humana KY Medicaid |
$282.69
|
| Rate for Payer: Kentucky WC Medicaid |
$285.56
|
| Rate for Payer: Kentucky WC Medicaid |
$407.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$961.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$674.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$606.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$865.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$288.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,031.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$723.36
|
| Rate for Payer: Ohio Health Group HMO |
$879.38
|
| Rate for Payer: Ohio Health Group HMO |
$616.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,020.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.18
|
| Rate for Payer: PHCS Commercial |
$789.12
|
| Rate for Payer: PHCS Commercial |
$1,125.60
|
| Rate for Payer: United Healthcare All Payer |
$723.36
|
| Rate for Payer: United Healthcare All Payer |
$1,031.80
|
|
