|
INTRODUCER OSCOR 7FR 6089
|
Facility
|
IP
|
$787.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.38
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
INTRODUCER PEELAWAY 10R
|
Facility
|
OP
|
$3,451.25
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,035.38 |
| Max. Negotiated Rate |
$3,313.20 |
| Rate for Payer: Aetna Commercial |
$2,657.46
|
| Rate for Payer: Anthem Medicaid |
$1,186.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,691.97
|
| Rate for Payer: Cash Price |
$1,725.62
|
| Rate for Payer: Cigna Commercial |
$2,864.54
|
| Rate for Payer: First Health Commercial |
$3,278.69
|
| Rate for Payer: Humana Commercial |
$2,933.56
|
| Rate for Payer: Humana KY Medicaid |
$1,186.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,198.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,210.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,588.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,761.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,002.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.36
|
| Rate for Payer: PHCS Commercial |
$3,313.20
|
| Rate for Payer: United Healthcare All Payer |
$3,037.10
|
|
|
INTRODUCER PEELAWAY 10R
|
Facility
|
IP
|
$3,451.25
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,035.38 |
| Max. Negotiated Rate |
$3,313.20 |
| Rate for Payer: Aetna Commercial |
$2,657.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,691.97
|
| Rate for Payer: Cash Price |
$1,725.62
|
| Rate for Payer: Cigna Commercial |
$2,864.54
|
| Rate for Payer: First Health Commercial |
$3,278.69
|
| Rate for Payer: Humana Commercial |
$2,933.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,588.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,761.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,002.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.36
|
| Rate for Payer: PHCS Commercial |
$3,313.20
|
| Rate for Payer: United Healthcare All Payer |
$3,037.10
|
|
|
INTRODUCER PEELAWAY 7FR
|
Facility
|
OP
|
$2,067.60
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.28 |
| Max. Negotiated Rate |
$1,984.90 |
| Rate for Payer: Aetna Commercial |
$1,592.05
|
| Rate for Payer: Anthem Medicaid |
$711.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,612.73
|
| Rate for Payer: Cash Price |
$1,033.80
|
| Rate for Payer: Cigna Commercial |
$1,716.11
|
| Rate for Payer: First Health Commercial |
$1,964.22
|
| Rate for Payer: Humana Commercial |
$1,757.46
|
| Rate for Payer: Humana KY Medicaid |
$711.05
|
| Rate for Payer: Kentucky WC Medicaid |
$718.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,525.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$725.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,798.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.64
|
| Rate for Payer: PHCS Commercial |
$1,984.90
|
| Rate for Payer: United Healthcare All Payer |
$1,819.49
|
|
|
INTRODUCER PEELAWAY 7FR
|
Facility
|
IP
|
$2,067.60
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.28 |
| Max. Negotiated Rate |
$1,984.90 |
| Rate for Payer: Aetna Commercial |
$1,592.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,612.73
|
| Rate for Payer: Cash Price |
$1,033.80
|
| Rate for Payer: Cigna Commercial |
$1,716.11
|
| Rate for Payer: First Health Commercial |
$1,964.22
|
| Rate for Payer: Humana Commercial |
$1,757.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,525.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,798.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.64
|
| Rate for Payer: PHCS Commercial |
$1,984.90
|
| Rate for Payer: United Healthcare All Payer |
$1,819.49
|
|
|
INTRODUCER PEELAWAY 8FR
|
Facility
|
IP
|
$2,067.60
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.28 |
| Max. Negotiated Rate |
$1,984.90 |
| Rate for Payer: Aetna Commercial |
$1,592.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,612.73
|
| Rate for Payer: Cash Price |
$1,033.80
|
| Rate for Payer: Cigna Commercial |
$1,716.11
|
| Rate for Payer: First Health Commercial |
$1,964.22
|
| Rate for Payer: Humana Commercial |
$1,757.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,525.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,798.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.64
|
| Rate for Payer: PHCS Commercial |
$1,984.90
|
| Rate for Payer: United Healthcare All Payer |
$1,819.49
|
|
|
INTRODUCER PEELAWAY 8FR
|
Facility
|
OP
|
$2,067.60
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.28 |
| Max. Negotiated Rate |
$1,984.90 |
| Rate for Payer: Aetna Commercial |
$1,592.05
|
| Rate for Payer: Anthem Medicaid |
$711.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,612.73
|
| Rate for Payer: Cash Price |
$1,033.80
|
| Rate for Payer: Cigna Commercial |
$1,716.11
|
| Rate for Payer: First Health Commercial |
$1,964.22
|
| Rate for Payer: Humana Commercial |
$1,757.46
|
| Rate for Payer: Humana KY Medicaid |
$711.05
|
| Rate for Payer: Kentucky WC Medicaid |
$718.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,525.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$725.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,798.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.64
|
| Rate for Payer: PHCS Commercial |
$1,984.90
|
| Rate for Payer: United Healthcare All Payer |
$1,819.49
|
|
|
INTRODUCER SAFESHEATH 7FR SU7
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODUCER SAFE SHEATH 8 FR
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem Medicaid |
$404.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Humana KY Medicaid |
$404.08
|
| Rate for Payer: Kentucky WC Medicaid |
$408.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$412.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
INTRODUCER SAFE SHEATH 8 FR
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
INTRODUCER SAFESHEATH 8FR SU8
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem Medicaid |
$404.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Humana KY Medicaid |
$404.08
|
| Rate for Payer: Kentucky WC Medicaid |
$408.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$412.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
INTRODUCER SAFESHEATH 8FR SU8
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
INTRODUCER SAFESHEATH 9FR SU9
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODUCER SAFESHEATH 9FR SU9
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODUCER SET 16 FR.
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
INTRODUCER SET 16 FR.
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
INTRODUCER/SHEATH 10F 6093
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem Medicaid |
$386.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Humana KY Medicaid |
$386.89
|
| Rate for Payer: Kentucky WC Medicaid |
$390.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.25
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
|
INTRODUCER/SHEATH 10F 6093
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.25
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
|
INTRODUCER/SHEATH 8FR 6091
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem Medicaid |
$386.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Humana KY Medicaid |
$386.89
|
| Rate for Payer: Kentucky WC Medicaid |
$390.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.25
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
|
INTRODUCER/SHEATH 8FR 6091
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.25
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
|
INTRODUCER/SHEATH 9F 6092
|
Facility
|
IP
|
$787.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.38
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
INTRODUCER/SHEATH 9F 6092
|
Facility
|
OP
|
$787.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem Medicaid |
$270.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Humana KY Medicaid |
$270.82
|
| Rate for Payer: Kentucky WC Medicaid |
$273.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.38
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
INTRODUCER SHEATH SET 7FR 7CM
|
Facility
|
OP
|
$752.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$722.40 |
| Rate for Payer: Aetna Commercial |
$579.42
|
| Rate for Payer: Anthem Medicaid |
$258.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$586.95
|
| Rate for Payer: Cash Price |
$376.25
|
| Rate for Payer: Cigna Commercial |
$624.58
|
| Rate for Payer: First Health Commercial |
$714.88
|
| Rate for Payer: Humana Commercial |
$639.62
|
| Rate for Payer: Humana KY Medicaid |
$258.78
|
| Rate for Payer: Kentucky WC Medicaid |
$261.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$617.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$555.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$662.20
|
| Rate for Payer: Ohio Health Group HMO |
$564.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$602.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.23
|
| Rate for Payer: PHCS Commercial |
$722.40
|
| Rate for Payer: United Healthcare All Payer |
$662.20
|
|
|
INTRODUCER SHEATH SET 7FR 7CM
|
Facility
|
IP
|
$752.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$722.40 |
| Rate for Payer: Aetna Commercial |
$579.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$586.95
|
| Rate for Payer: Cash Price |
$376.25
|
| Rate for Payer: Cigna Commercial |
$624.58
|
| Rate for Payer: First Health Commercial |
$714.88
|
| Rate for Payer: Humana Commercial |
$639.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$617.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$555.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$662.20
|
| Rate for Payer: Ohio Health Group HMO |
$564.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$602.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.23
|
| Rate for Payer: PHCS Commercial |
$722.40
|
| Rate for Payer: United Healthcare All Payer |
$662.20
|
|
