|
INTRODUCER 9FR VIK9S129
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODUCER BILIARY HOWELL
|
Facility
|
OP
|
$1,074.46
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$1,031.48 |
| Rate for Payer: Aetna Commercial |
$827.33
|
| Rate for Payer: Anthem Medicaid |
$369.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.08
|
| Rate for Payer: Cash Price |
$537.23
|
| Rate for Payer: Cigna Commercial |
$891.80
|
| Rate for Payer: First Health Commercial |
$1,020.74
|
| Rate for Payer: Humana Commercial |
$913.29
|
| Rate for Payer: Humana KY Medicaid |
$369.51
|
| Rate for Payer: Kentucky WC Medicaid |
$373.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$376.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.52
|
| Rate for Payer: Ohio Health Group HMO |
$805.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.08
|
| Rate for Payer: PHCS Commercial |
$1,031.48
|
| Rate for Payer: United Healthcare All Payer |
$945.52
|
|
|
INTRODUCER BILIARY HOWELL
|
Facility
|
IP
|
$1,074.46
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$1,031.48 |
| Rate for Payer: Aetna Commercial |
$827.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.08
|
| Rate for Payer: Cash Price |
$537.23
|
| Rate for Payer: Cigna Commercial |
$891.80
|
| Rate for Payer: First Health Commercial |
$1,020.74
|
| Rate for Payer: Humana Commercial |
$913.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.52
|
| Rate for Payer: Ohio Health Group HMO |
$805.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.08
|
| Rate for Payer: PHCS Commercial |
$1,031.48
|
| Rate for Payer: United Healthcare All Payer |
$945.52
|
|
|
INTRODUCER KIT 6207-D1
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem Medicaid |
$526.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Humana KY Medicaid |
$526.17
|
| Rate for Payer: Kentucky WC Medicaid |
$531.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
INTRODUCER KIT 6207-D1
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
INTRODUCER KIT 6209-S1
|
Facility
|
IP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
|
INTRODUCER KIT 6209-S1
|
Facility
|
OP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem Medicaid |
$373.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Humana KY Medicaid |
$373.65
|
| Rate for Payer: Kentucky WC Medicaid |
$377.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$381.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
|
INTRODUCER KIT F/GASTRO 24FR D
|
Facility
|
IP
|
$2,119.90
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.59 |
| Max. Negotiated Rate |
$2,035.10 |
| Rate for Payer: Aetna Commercial |
$1,632.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.52
|
| Rate for Payer: Cash Price |
$1,059.95
|
| Rate for Payer: Cigna Commercial |
$1,759.52
|
| Rate for Payer: First Health Commercial |
$2,013.90
|
| Rate for Payer: Humana Commercial |
$1,801.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,589.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$423.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.17
|
| Rate for Payer: PHCS Commercial |
$2,035.10
|
| Rate for Payer: United Healthcare All Payer |
$1,865.51
|
|
|
INTRODUCER KIT F/GASTRO 24FR D
|
Facility
|
OP
|
$2,119.90
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.59 |
| Max. Negotiated Rate |
$2,035.10 |
| Rate for Payer: Aetna Commercial |
$1,632.32
|
| Rate for Payer: Anthem Medicaid |
$729.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.52
|
| Rate for Payer: Cash Price |
$1,059.95
|
| Rate for Payer: Cigna Commercial |
$1,759.52
|
| Rate for Payer: First Health Commercial |
$2,013.90
|
| Rate for Payer: Humana Commercial |
$1,801.92
|
| Rate for Payer: Humana KY Medicaid |
$729.03
|
| Rate for Payer: Kentucky WC Medicaid |
$736.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,589.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$423.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.17
|
| Rate for Payer: PHCS Commercial |
$2,035.10
|
| Rate for Payer: United Healthcare All Payer |
$1,865.51
|
|
|
INTRODUCER KIT F/JEJUNAL/TRANS
|
Facility
|
IP
|
$2,133.37
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.34 |
| Max. Negotiated Rate |
$2,048.04 |
| Rate for Payer: Aetna Commercial |
$1,642.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,664.03
|
| Rate for Payer: Cash Price |
$1,066.68
|
| Rate for Payer: Cigna Commercial |
$1,770.70
|
| Rate for Payer: First Health Commercial |
$2,026.70
|
| Rate for Payer: Humana Commercial |
$1,813.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,749.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,574.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,877.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,600.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$426.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.34
|
| Rate for Payer: PHCS Commercial |
$2,048.04
|
| Rate for Payer: United Healthcare All Payer |
$1,877.37
|
|
|
INTRODUCER KIT F/JEJUNAL/TRANS
|
Facility
|
OP
|
$2,133.37
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.34 |
| Max. Negotiated Rate |
$2,048.04 |
| Rate for Payer: Aetna Commercial |
$1,642.69
|
| Rate for Payer: Anthem Medicaid |
$733.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,664.03
|
| Rate for Payer: Cash Price |
$1,066.68
|
| Rate for Payer: Cigna Commercial |
$1,770.70
|
| Rate for Payer: First Health Commercial |
$2,026.70
|
| Rate for Payer: Humana Commercial |
$1,813.36
|
| Rate for Payer: Humana KY Medicaid |
$733.67
|
| Rate for Payer: Kentucky WC Medicaid |
$741.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,749.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,574.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$748.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,877.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,600.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$426.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.34
|
| Rate for Payer: PHCS Commercial |
$2,048.04
|
| Rate for Payer: United Healthcare All Payer |
$1,877.37
|
|
|
INTRODUCER OPTISEAL11FR 13CM
|
Facility
|
IP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
INTRODUCER OPTISEAL11FR 13CM
|
Facility
|
OP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem Medicaid |
$388.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Humana KY Medicaid |
$388.44
|
| Rate for Payer: Kentucky WC Medicaid |
$392.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
INTRODUCER OPTISEAL 7FR 25CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODUCER OPTISEAL 7FR 25CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODUCER OPTISEAL 9FR 13CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODUCER OPTISEAL 9FR 13CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODUCER OSCOR 7FR 6089
|
Facility
|
IP
|
$768.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.94 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$591.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.62
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cigna Commercial |
$638.06
|
| Rate for Payer: First Health Commercial |
$730.31
|
| Rate for Payer: Humana Commercial |
$653.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.50
|
| Rate for Payer: Ohio Health Group HMO |
$576.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.31
|
| Rate for Payer: PHCS Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Payer |
$676.50
|
|
|
INTRODUCER OSCOR 7FR 6089
|
Facility
|
OP
|
$768.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.94 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$591.94
|
| Rate for Payer: Anthem Medicaid |
$264.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.62
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cigna Commercial |
$638.06
|
| Rate for Payer: First Health Commercial |
$730.31
|
| Rate for Payer: Humana Commercial |
$653.44
|
| Rate for Payer: Humana KY Medicaid |
$264.37
|
| Rate for Payer: Kentucky WC Medicaid |
$267.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.50
|
| Rate for Payer: Ohio Health Group HMO |
$576.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.31
|
| Rate for Payer: PHCS Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Payer |
$676.50
|
|
|
INTRODUCER PEELAWAY 10R
|
Facility
|
OP
|
$2,057.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.41 |
| Max. Negotiated Rate |
$1,974.72 |
| Rate for Payer: Aetna Commercial |
$1,583.89
|
| Rate for Payer: Anthem Medicaid |
$707.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.46
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cigna Commercial |
$1,707.31
|
| Rate for Payer: First Health Commercial |
$1,954.15
|
| Rate for Payer: Humana Commercial |
$1,748.45
|
| Rate for Payer: Humana KY Medicaid |
$707.40
|
| Rate for Payer: Kentucky WC Medicaid |
$714.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.67
|
| Rate for Payer: PHCS Commercial |
$1,974.72
|
| Rate for Payer: United Healthcare All Payer |
$1,810.16
|
|
|
INTRODUCER PEELAWAY 10R
|
Facility
|
IP
|
$2,057.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.41 |
| Max. Negotiated Rate |
$1,974.72 |
| Rate for Payer: Aetna Commercial |
$1,583.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.46
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cigna Commercial |
$1,707.31
|
| Rate for Payer: First Health Commercial |
$1,954.15
|
| Rate for Payer: Humana Commercial |
$1,748.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.67
|
| Rate for Payer: PHCS Commercial |
$1,974.72
|
| Rate for Payer: United Healthcare All Payer |
$1,810.16
|
|
|
INTRODUCER PEELAWAY 7FR
|
Facility
|
IP
|
$2,057.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.41 |
| Max. Negotiated Rate |
$1,974.72 |
| Rate for Payer: Aetna Commercial |
$1,583.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.46
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cigna Commercial |
$1,707.31
|
| Rate for Payer: First Health Commercial |
$1,954.15
|
| Rate for Payer: Humana Commercial |
$1,748.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.67
|
| Rate for Payer: PHCS Commercial |
$1,974.72
|
| Rate for Payer: United Healthcare All Payer |
$1,810.16
|
|
|
INTRODUCER PEELAWAY 7FR
|
Facility
|
OP
|
$2,057.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.41 |
| Max. Negotiated Rate |
$1,974.72 |
| Rate for Payer: Aetna Commercial |
$1,583.89
|
| Rate for Payer: Anthem Medicaid |
$707.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.46
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cigna Commercial |
$1,707.31
|
| Rate for Payer: First Health Commercial |
$1,954.15
|
| Rate for Payer: Humana Commercial |
$1,748.45
|
| Rate for Payer: Humana KY Medicaid |
$707.40
|
| Rate for Payer: Kentucky WC Medicaid |
$714.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.67
|
| Rate for Payer: PHCS Commercial |
$1,974.72
|
| Rate for Payer: United Healthcare All Payer |
$1,810.16
|
|
|
INTRODUCER PEELAWAY 8FR
|
Facility
|
IP
|
$2,057.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.41 |
| Max. Negotiated Rate |
$1,974.72 |
| Rate for Payer: Aetna Commercial |
$1,583.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.46
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cigna Commercial |
$1,707.31
|
| Rate for Payer: First Health Commercial |
$1,954.15
|
| Rate for Payer: Humana Commercial |
$1,748.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.67
|
| Rate for Payer: PHCS Commercial |
$1,974.72
|
| Rate for Payer: United Healthcare All Payer |
$1,810.16
|
|
|
INTRODUCER PEELAWAY 8FR
|
Facility
|
OP
|
$2,057.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.41 |
| Max. Negotiated Rate |
$1,974.72 |
| Rate for Payer: Aetna Commercial |
$1,583.89
|
| Rate for Payer: Anthem Medicaid |
$707.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.46
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cigna Commercial |
$1,707.31
|
| Rate for Payer: First Health Commercial |
$1,954.15
|
| Rate for Payer: Humana Commercial |
$1,748.45
|
| Rate for Payer: Humana KY Medicaid |
$707.40
|
| Rate for Payer: Kentucky WC Medicaid |
$714.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.67
|
| Rate for Payer: PHCS Commercial |
$1,974.72
|
| Rate for Payer: United Healthcare All Payer |
$1,810.16
|
|
