|
GUIDE CATH JR 3.5 8FR
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
GUIDE CAT JL 4.0 8FR
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
GUIDE CAT JL 4.0 8FR
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
GUIDELINER 5.5FR
|
Facility
|
IP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
GUIDELINER 5.5FR
|
Facility
|
OP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem Medicaid |
$1,171.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Humana KY Medicaid |
$1,171.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
GUIDELINER CATH 6FR
|
Facility
|
IP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
GUIDELINER CATH 6FR
|
Facility
|
OP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem Medicaid |
$1,171.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Humana KY Medicaid |
$1,171.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
GUIDELINER CATH 7FR
|
Facility
|
IP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
GUIDELINER CATH 7FR
|
Facility
|
OP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem Medicaid |
$1,171.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Humana KY Medicaid |
$1,171.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
GUIDE PIN TIP THRD 3.2*343MM
|
Facility
|
IP
|
$1,896.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.98 |
| Max. Negotiated Rate |
$1,820.74 |
| Rate for Payer: Aetna Commercial |
$1,460.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,479.35
|
| Rate for Payer: Cash Price |
$948.30
|
| Rate for Payer: Cigna Commercial |
$1,574.18
|
| Rate for Payer: First Health Commercial |
$1,801.77
|
| Rate for Payer: Humana Commercial |
$1,612.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,555.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,669.01
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,517.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,650.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.65
|
| Rate for Payer: PHCS Commercial |
$1,820.74
|
| Rate for Payer: United Healthcare All Payer |
$1,669.01
|
|
|
GUIDE PIN TIP THRD 3.2*343MM
|
Facility
|
OP
|
$1,896.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.98 |
| Max. Negotiated Rate |
$1,820.74 |
| Rate for Payer: Aetna Commercial |
$1,460.38
|
| Rate for Payer: Anthem Medicaid |
$652.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,479.35
|
| Rate for Payer: Cash Price |
$948.30
|
| Rate for Payer: Cigna Commercial |
$1,574.18
|
| Rate for Payer: First Health Commercial |
$1,801.77
|
| Rate for Payer: Humana Commercial |
$1,612.11
|
| Rate for Payer: Humana KY Medicaid |
$652.24
|
| Rate for Payer: Kentucky WC Medicaid |
$658.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,555.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,669.01
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,517.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,650.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.65
|
| Rate for Payer: PHCS Commercial |
$1,820.74
|
| Rate for Payer: United Healthcare All Payer |
$1,669.01
|
|
|
GUIDE PIN TIP THREADED 279.4
|
Facility
|
IP
|
$550.42
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.13 |
| Max. Negotiated Rate |
$528.40 |
| Rate for Payer: Aetna Commercial |
$423.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.33
|
| Rate for Payer: Cash Price |
$275.21
|
| Rate for Payer: Cigna Commercial |
$456.85
|
| Rate for Payer: First Health Commercial |
$522.90
|
| Rate for Payer: Humana Commercial |
$467.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.37
|
| Rate for Payer: Ohio Health Group HMO |
$412.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.79
|
| Rate for Payer: PHCS Commercial |
$528.40
|
| Rate for Payer: United Healthcare All Payer |
$484.37
|
|
|
GUIDE PIN TIP THREADED 279.4
|
Facility
|
OP
|
$550.42
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.13 |
| Max. Negotiated Rate |
$528.40 |
| Rate for Payer: Aetna Commercial |
$423.82
|
| Rate for Payer: Anthem Medicaid |
$189.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.33
|
| Rate for Payer: Cash Price |
$275.21
|
| Rate for Payer: Cigna Commercial |
$456.85
|
| Rate for Payer: First Health Commercial |
$522.90
|
| Rate for Payer: Humana Commercial |
$467.86
|
| Rate for Payer: Humana KY Medicaid |
$189.29
|
| Rate for Payer: Kentucky WC Medicaid |
$191.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.37
|
| Rate for Payer: Ohio Health Group HMO |
$412.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.79
|
| Rate for Payer: PHCS Commercial |
$528.40
|
| Rate for Payer: United Healthcare All Payer |
$484.37
|
|
|
GUIDE ROD GRADBALL TIP 2.0*600
|
Facility
|
OP
|
$1,772.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.66 |
| Max. Negotiated Rate |
$1,701.30 |
| Rate for Payer: Aetna Commercial |
$1,364.59
|
| Rate for Payer: Anthem Medicaid |
$609.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,382.31
|
| Rate for Payer: Cash Price |
$886.09
|
| Rate for Payer: Cigna Commercial |
$1,470.92
|
| Rate for Payer: First Health Commercial |
$1,683.58
|
| Rate for Payer: Humana Commercial |
$1,506.36
|
| Rate for Payer: Humana KY Medicaid |
$609.46
|
| Rate for Payer: Kentucky WC Medicaid |
$615.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,559.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,417.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,541.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.81
|
| Rate for Payer: PHCS Commercial |
$1,701.30
|
| Rate for Payer: United Healthcare All Payer |
$1,559.53
|
|
|
GUIDE ROD GRADBALL TIP 2.0*600
|
Facility
|
IP
|
$1,772.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.66 |
| Max. Negotiated Rate |
$1,701.30 |
| Rate for Payer: Aetna Commercial |
$1,364.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,382.31
|
| Rate for Payer: Cash Price |
$886.09
|
| Rate for Payer: Cigna Commercial |
$1,470.92
|
| Rate for Payer: First Health Commercial |
$1,683.58
|
| Rate for Payer: Humana Commercial |
$1,506.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,559.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,417.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,541.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.81
|
| Rate for Payer: PHCS Commercial |
$1,701.30
|
| Rate for Payer: United Healthcare All Payer |
$1,559.53
|
|
|
GUIDE SHEATH KIT K-401
|
Facility
|
OP
|
$3,012.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$903.75 |
| Max. Negotiated Rate |
$2,892.00 |
| Rate for Payer: Aetna Commercial |
$2,319.62
|
| Rate for Payer: Anthem Medicaid |
$1,036.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,349.75
|
| Rate for Payer: Cash Price |
$1,506.25
|
| Rate for Payer: Cigna Commercial |
$2,500.38
|
| Rate for Payer: First Health Commercial |
$2,861.88
|
| Rate for Payer: Humana Commercial |
$2,560.62
|
| Rate for Payer: Humana KY Medicaid |
$1,036.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,046.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,470.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,223.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$903.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,056.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,651.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,259.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.62
|
| Rate for Payer: PHCS Commercial |
$2,892.00
|
| Rate for Payer: United Healthcare All Payer |
$2,651.00
|
|
|
GUIDE SHEATH KIT K-401
|
Facility
|
IP
|
$3,012.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$903.75 |
| Max. Negotiated Rate |
$2,892.00 |
| Rate for Payer: Aetna Commercial |
$2,319.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,349.75
|
| Rate for Payer: Cash Price |
$1,506.25
|
| Rate for Payer: Cigna Commercial |
$2,500.38
|
| Rate for Payer: First Health Commercial |
$2,861.88
|
| Rate for Payer: Humana Commercial |
$2,560.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,470.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,223.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$903.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,651.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,259.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.62
|
| Rate for Payer: PHCS Commercial |
$2,892.00
|
| Rate for Payer: United Healthcare All Payer |
$2,651.00
|
|
|
GUIDE SHEATH KIT K-402
|
Facility
|
IP
|
$1,740.34
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.10 |
| Max. Negotiated Rate |
$1,670.73 |
| Rate for Payer: Aetna Commercial |
$1,340.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.47
|
| Rate for Payer: Cash Price |
$870.17
|
| Rate for Payer: Cigna Commercial |
$1,444.48
|
| Rate for Payer: First Health Commercial |
$1,653.32
|
| Rate for Payer: Humana Commercial |
$1,479.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,427.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,514.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.83
|
| Rate for Payer: PHCS Commercial |
$1,670.73
|
| Rate for Payer: United Healthcare All Payer |
$1,531.50
|
|
|
GUIDE SHEATH KIT K-402
|
Facility
|
OP
|
$1,740.34
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.10 |
| Max. Negotiated Rate |
$1,670.73 |
| Rate for Payer: Aetna Commercial |
$1,340.06
|
| Rate for Payer: Anthem Medicaid |
$598.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.47
|
| Rate for Payer: Cash Price |
$870.17
|
| Rate for Payer: Cigna Commercial |
$1,444.48
|
| Rate for Payer: First Health Commercial |
$1,653.32
|
| Rate for Payer: Humana Commercial |
$1,479.29
|
| Rate for Payer: Humana KY Medicaid |
$598.50
|
| Rate for Payer: Kentucky WC Medicaid |
$604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,427.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,514.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.83
|
| Rate for Payer: PHCS Commercial |
$1,670.73
|
| Rate for Payer: United Healthcare All Payer |
$1,531.50
|
|
|
GUIDE SPRING WIRE DUOFLEX
|
Facility
|
IP
|
$448.43
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.53 |
| Max. Negotiated Rate |
$430.49 |
| Rate for Payer: Aetna Commercial |
$345.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$349.78
|
| Rate for Payer: Cash Price |
$224.22
|
| Rate for Payer: Cigna Commercial |
$372.20
|
| Rate for Payer: First Health Commercial |
$426.01
|
| Rate for Payer: Humana Commercial |
$381.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$367.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$330.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$394.62
|
| Rate for Payer: Ohio Health Group HMO |
$336.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$309.42
|
| Rate for Payer: PHCS Commercial |
$430.49
|
| Rate for Payer: United Healthcare All Payer |
$394.62
|
|
|
GUIDE SPRING WIRE DUOFLEX
|
Facility
|
OP
|
$448.43
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.53 |
| Max. Negotiated Rate |
$430.49 |
| Rate for Payer: Aetna Commercial |
$345.29
|
| Rate for Payer: Anthem Medicaid |
$154.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$349.78
|
| Rate for Payer: Cash Price |
$224.22
|
| Rate for Payer: Cigna Commercial |
$372.20
|
| Rate for Payer: First Health Commercial |
$426.01
|
| Rate for Payer: Humana Commercial |
$381.17
|
| Rate for Payer: Humana KY Medicaid |
$154.22
|
| Rate for Payer: Kentucky WC Medicaid |
$155.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$367.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$330.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$394.62
|
| Rate for Payer: Ohio Health Group HMO |
$336.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$309.42
|
| Rate for Payer: PHCS Commercial |
$430.49
|
| Rate for Payer: United Healthcare All Payer |
$394.62
|
|
|
GUIDEWIRE
|
Facility
|
OP
|
$1,699.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem Medicaid |
$584.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Humana KY Medicaid |
$584.29
|
| Rate for Payer: Kentucky WC Medicaid |
$590.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
GUIDEWIRE
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
GUIDEWIRE
|
Facility
|
IP
|
$1,699.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
GUIDEWIRE
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
