|
INTRODUCER SAFESHEATH 7FR SU7
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
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 SAFESHEATH 7FR SU7
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
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 SAFE SHEATH 8 FR
|
Facility
|
OP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
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 SAFE SHEATH 8 FR
|
Facility
|
IP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
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 SAFESHEATH 8FR SU8
|
Facility
|
OP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
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 SAFESHEATH 8FR SU8
|
Facility
|
IP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
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 SAFESHEATH 9FR SU9
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
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 SAFESHEATH 9FR SU9
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
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 SET 16 FR.
|
Facility
|
IP
|
$1,125.20
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$1,080.19 |
| Rate for Payer: Aetna Commercial |
$866.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.66
|
| Rate for Payer: Cash Price |
$562.60
|
| Rate for Payer: Cigna Commercial |
$933.92
|
| Rate for Payer: First Health Commercial |
$1,068.94
|
| Rate for Payer: Humana Commercial |
$956.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.18
|
| Rate for Payer: Ohio Health Group HMO |
$843.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.81
|
| Rate for Payer: PHCS Commercial |
$1,080.19
|
| Rate for Payer: United Healthcare All Payer |
$990.18
|
|
|
INTRODUCER SET 16 FR.
|
Facility
|
OP
|
$1,125.20
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$1,080.19 |
| Rate for Payer: Aetna Commercial |
$866.40
|
| Rate for Payer: Anthem Medicaid |
$386.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.66
|
| Rate for Payer: Cash Price |
$562.60
|
| Rate for Payer: Cigna Commercial |
$933.92
|
| Rate for Payer: First Health Commercial |
$1,068.94
|
| Rate for Payer: Humana Commercial |
$956.42
|
| Rate for Payer: Humana KY Medicaid |
$386.96
|
| Rate for Payer: Kentucky WC Medicaid |
$390.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.18
|
| Rate for Payer: Ohio Health Group HMO |
$843.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.81
|
| Rate for Payer: PHCS Commercial |
$1,080.19
|
| Rate for Payer: United Healthcare All Payer |
$990.18
|
|
|
INTRODUCER/SHEATH 10F 6093
|
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/SHEATH 10F 6093
|
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/SHEATH 8FR 6091
|
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/SHEATH 8FR 6091
|
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/SHEATH 9F 6092
|
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/SHEATH 9F 6092
|
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 SHEATH SET 7FR 7CM
|
Facility
|
OP
|
$737.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$707.76 |
| Rate for Payer: Aetna Commercial |
$567.68
|
| Rate for Payer: Anthem Medicaid |
$253.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$575.06
|
| Rate for Payer: Cash Price |
$368.62
|
| Rate for Payer: Cigna Commercial |
$611.92
|
| Rate for Payer: First Health Commercial |
$700.39
|
| Rate for Payer: Humana Commercial |
$626.66
|
| Rate for Payer: Humana KY Medicaid |
$253.54
|
| Rate for Payer: Kentucky WC Medicaid |
$256.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$544.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.78
|
| Rate for Payer: Ohio Health Group HMO |
$552.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.55
|
| Rate for Payer: PHCS Commercial |
$707.76
|
| Rate for Payer: United Healthcare All Payer |
$648.78
|
|
|
INTRODUCER SHEATH SET 7FR 7CM
|
Facility
|
IP
|
$737.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$707.76 |
| Rate for Payer: Aetna Commercial |
$567.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$575.06
|
| Rate for Payer: Cash Price |
$368.62
|
| Rate for Payer: Cigna Commercial |
$611.92
|
| Rate for Payer: First Health Commercial |
$700.39
|
| Rate for Payer: Humana Commercial |
$626.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$544.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.78
|
| Rate for Payer: Ohio Health Group HMO |
$552.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.55
|
| Rate for Payer: PHCS Commercial |
$707.76
|
| Rate for Payer: United Healthcare All Payer |
$648.78
|
|
|
INTRODUCER SHEATH ULTRA 9FR*23
|
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 SHEATH ULTRA 9FR*23
|
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 TLA
|
Facility
|
OP
|
$736.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.78 |
| Max. Negotiated Rate |
$707.33 |
| Rate for Payer: Aetna Commercial |
$567.34
|
| Rate for Payer: Anthem Medicaid |
$253.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.70
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$611.54
|
| Rate for Payer: First Health Commercial |
$699.96
|
| Rate for Payer: Humana Commercial |
$626.28
|
| Rate for Payer: Humana KY Medicaid |
$253.39
|
| Rate for Payer: Kentucky WC Medicaid |
$255.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.38
|
| Rate for Payer: Ohio Health Group HMO |
$552.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.41
|
| Rate for Payer: PHCS Commercial |
$707.33
|
| Rate for Payer: United Healthcare All Payer |
$648.38
|
|
|
INTRODUCER TLA
|
Facility
|
IP
|
$736.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.78 |
| Max. Negotiated Rate |
$707.33 |
| Rate for Payer: Aetna Commercial |
$567.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.70
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$611.54
|
| Rate for Payer: First Health Commercial |
$699.96
|
| Rate for Payer: Humana Commercial |
$626.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.38
|
| Rate for Payer: Ohio Health Group HMO |
$552.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.41
|
| Rate for Payer: PHCS Commercial |
$707.33
|
| Rate for Payer: United Healthcare All Payer |
$648.38
|
|
|
INTRODUCTION OF GI TUBE
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 44500
|
| Hospital Charge Code |
76101853
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.38 |
| Max. Negotiated Rate |
$1,097.45 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem Medicaid |
$387.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Humana KY Medicaid |
$387.23
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$391.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.06
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
INTRODUCTION OF GI TUBE
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 44500
|
| Hospital Charge Code |
76101853
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.38 |
| Max. Negotiated Rate |
$1,080.96 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.06
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT; WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY
|
Facility
|
OP
|
$6,919.70
|
|
|
Service Code
|
CPT 36902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,942.64 |
| Max. Negotiated Rate |
$6,919.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
|
