|
ANOSCOPY; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$154.64
|
|
|
Service Code
|
CPT 46600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$110.46 |
| Max. Negotiated Rate |
$154.64 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
|
|
ANOSCOPY(P
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 46615
|
| Hospital Charge Code |
761P1932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.09 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna Commercial |
$150.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.09
|
| Rate for Payer: Anthem Medicaid |
$105.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$295.00
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$294.98
|
| Rate for Payer: Healthspan PPO |
$179.04
|
| Rate for Payer: Humana Medicaid |
$105.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$120.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.61
|
| Rate for Payer: Molina Healthcare Passport |
$105.50
|
| Rate for Payer: Multiplan PHCS |
$177.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.50
|
| Rate for Payer: UHCCP Medicaid |
$97.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.56
|
|
|
ANOSCOPY REMOVE FOR BODY
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 46608
|
| Hospital Charge Code |
761P2630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.28 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.28
|
| Rate for Payer: Anthem Medicaid |
$75.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$285.00
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$124.65
|
| Rate for Payer: Healthspan PPO |
$247.12
|
| Rate for Payer: Humana Medicaid |
$75.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.44
|
| Rate for Payer: Molina Healthcare Passport |
$75.92
|
| Rate for Payer: Multiplan PHCS |
$171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$199.50
|
| Rate for Payer: UHCCP Medicaid |
$75.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.68
|
|
|
ANOSCOPY REMOVE FOR BODY
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 46608
|
| Hospital Charge Code |
76102630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.30
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.35
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
ANOSCOPY REMOVE FOR BODY
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 46608
|
| Hospital Charge Code |
76102630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.28 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.28
|
| Rate for Payer: Anthem Medicaid |
$75.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$285.00
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$124.65
|
| Rate for Payer: Healthspan PPO |
$247.12
|
| Rate for Payer: Humana Medicaid |
$75.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.44
|
| Rate for Payer: Molina Healthcare Passport |
$75.92
|
| Rate for Payer: Multiplan PHCS |
$171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$199.50
|
| Rate for Payer: UHCCP Medicaid |
$75.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.68
|
|
|
ANOSCOPY REMOVE FOR BODY
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 46608
|
| Hospital Charge Code |
76102630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$1,106.49 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem Medicaid |
$98.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Humana KY Medicaid |
$98.01
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$99.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.35
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
ANOSCOPY - REMOVE LESION
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 46610
|
| Hospital Charge Code |
76101928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
ANOSCOPY - REMOVE LESION
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 46610
|
| Hospital Charge Code |
76101928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$117.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.04
|
| Rate for Payer: Anthem Medicaid |
$65.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$440.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$113.49
|
| Rate for Payer: Healthspan PPO |
$244.19
|
| Rate for Payer: Humana Medicaid |
$65.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.48
|
| Rate for Payer: Molina Healthcare Passport |
$65.18
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$308.00
|
| Rate for Payer: UHCCP Medicaid |
$65.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.83
|
|
|
ANOSCOPY - REMOVE LESION
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 46610
|
| Hospital Charge Code |
76101928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$151.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
ANOSCOPY - REMOVE LESION(P
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 46610
|
| Hospital Charge Code |
761P1928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$117.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.04
|
| Rate for Payer: Anthem Medicaid |
$65.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$440.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$113.49
|
| Rate for Payer: Healthspan PPO |
$244.19
|
| Rate for Payer: Humana Medicaid |
$65.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.48
|
| Rate for Payer: Molina Healthcare Passport |
$65.18
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$308.00
|
| Rate for Payer: UHCCP Medicaid |
$65.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.83
|
|
|
ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$1,428.66
|
|
|
Service Code
|
CPT 46606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.47 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
|
|
ANSCOPE REMOV LESION
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 46612
|
| Hospital Charge Code |
76101930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.94 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$146.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.94
|
| Rate for Payer: Anthem Medicaid |
$110.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$416.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$193.89
|
| Rate for Payer: Healthspan PPO |
$295.65
|
| Rate for Payer: Humana Medicaid |
$110.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$113.03
|
| Rate for Payer: Molina Healthcare Passport |
$110.81
|
| Rate for Payer: Multiplan PHCS |
$249.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$291.20
|
| Rate for Payer: UHCCP Medicaid |
$102.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.92
|
|
|
ANSCOPE REMOV LESION
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
HCPCS 46612
|
| Hospital Charge Code |
76101930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$399.36 |
| Rate for Payer: Aetna Commercial |
$320.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$324.48
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$345.28
|
| Rate for Payer: First Health Commercial |
$395.20
|
| Rate for Payer: Humana Commercial |
$353.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.08
|
| Rate for Payer: Ohio Health Group HMO |
$312.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.96
|
| Rate for Payer: PHCS Commercial |
$399.36
|
| Rate for Payer: United Healthcare All Payer |
$366.08
|
|
|
ANSCOPE REMOV LESION
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
HCPCS 46612
|
| Hospital Charge Code |
76101930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$320.32
|
| Rate for Payer: Anthem Medicaid |
$143.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$324.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$345.28
|
| Rate for Payer: First Health Commercial |
$395.20
|
| Rate for Payer: Humana Commercial |
$353.60
|
| Rate for Payer: Humana KY Medicaid |
$143.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$145.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.08
|
| Rate for Payer: Ohio Health Group HMO |
$312.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.96
|
| Rate for Payer: PHCS Commercial |
$399.36
|
| Rate for Payer: United Healthcare All Payer |
$366.08
|
|
|
ANSCOPE REMOV LESION(P
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 46612
|
| Hospital Charge Code |
761P1930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.94 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$146.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.94
|
| Rate for Payer: Anthem Medicaid |
$110.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$416.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$193.89
|
| Rate for Payer: Healthspan PPO |
$295.65
|
| Rate for Payer: Humana Medicaid |
$110.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$113.03
|
| Rate for Payer: Molina Healthcare Passport |
$110.81
|
| Rate for Payer: Multiplan PHCS |
$249.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$291.20
|
| Rate for Payer: UHCCP Medicaid |
$102.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.92
|
|
|
ANSEL GUIDE SHEATH 6FR 90CM
|
Facility
|
IP
|
$1,878.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$1,803.36 |
| Rate for Payer: Aetna Commercial |
$1,446.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.23
|
| Rate for Payer: Cash Price |
$939.25
|
| Rate for Payer: Cigna Commercial |
$1,559.16
|
| Rate for Payer: First Health Commercial |
$1,784.58
|
| Rate for Payer: Humana Commercial |
$1,596.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,653.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.34
|
| Rate for Payer: PHCS Commercial |
$1,803.36
|
| Rate for Payer: United Healthcare All Payer |
$1,653.08
|
|
|
ANSEL GUIDE SHEATH 6FR 90CM
|
Facility
|
OP
|
$1,878.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$1,803.36 |
| Rate for Payer: Aetna Commercial |
$1,446.44
|
| Rate for Payer: Anthem Medicaid |
$646.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.23
|
| Rate for Payer: Cash Price |
$939.25
|
| Rate for Payer: Cigna Commercial |
$1,559.16
|
| Rate for Payer: First Health Commercial |
$1,784.58
|
| Rate for Payer: Humana Commercial |
$1,596.72
|
| Rate for Payer: Humana KY Medicaid |
$646.02
|
| Rate for Payer: Kentucky WC Medicaid |
$652.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,653.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.34
|
| Rate for Payer: PHCS Commercial |
$1,803.36
|
| Rate for Payer: United Healthcare All Payer |
$1,653.08
|
|
|
ANSEL GUIDE SHEATH 7FR 90CM
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
ANSEL GUIDE SHEATH 7FR 90CM
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
ANSEL SHEATH 5F
|
Facility
|
IP
|
$1,899.64
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.95 |
| Max. Negotiated Rate |
$1,823.65 |
| Rate for Payer: Aetna Commercial |
$1,462.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.72
|
| Rate for Payer: Cash Price |
$949.82
|
| Rate for Payer: Cigna Commercial |
$1,576.70
|
| Rate for Payer: First Health Commercial |
$1,804.66
|
| Rate for Payer: Humana Commercial |
$1,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,401.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,671.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.89
|
| Rate for Payer: PHCS Commercial |
$1,823.65
|
| Rate for Payer: United Healthcare All Payer |
$1,671.68
|
|
|
ANSEL SHEATH 5F
|
Facility
|
OP
|
$1,899.64
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.95 |
| Max. Negotiated Rate |
$1,823.65 |
| Rate for Payer: Aetna Commercial |
$1,462.72
|
| Rate for Payer: Anthem Medicaid |
$653.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.72
|
| Rate for Payer: Cash Price |
$949.82
|
| Rate for Payer: Cigna Commercial |
$1,576.70
|
| Rate for Payer: First Health Commercial |
$1,804.66
|
| Rate for Payer: Humana Commercial |
$1,614.69
|
| Rate for Payer: Humana KY Medicaid |
$653.29
|
| Rate for Payer: Kentucky WC Medicaid |
$659.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,401.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,671.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.89
|
| Rate for Payer: PHCS Commercial |
$1,823.65
|
| Rate for Payer: United Healthcare All Payer |
$1,671.68
|
|
|
ANSEL SHEATH 6F 45CM
|
Facility
|
OP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem Medicaid |
$520.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Humana KY Medicaid |
$520.15
|
| Rate for Payer: Kentucky WC Medicaid |
$525.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
ANSEL SHEATH 6F 45CM
|
Facility
|
IP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
ANSEL SHEATH HI FLEX 5F
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
ANSEL SHEATH HI FLEX 5F
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
