|
SENSITIVI DISK METHOD PER PLAT
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
30001320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$13.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$6.00
|
| Rate for Payer: Healthspan PPO |
$7.22
|
| Rate for Payer: Multiplan PHCS |
$46.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.60
|
| Rate for Payer: UHCCP Medicaid |
$27.30
|
|
|
SENSITIVI DISK METHOD PER PLAT
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
30001320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem Medicaid |
$26.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.48
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Humana KY Medicaid |
$26.82
|
| Rate for Payer: Humana Medicare Advantage |
$7.48
|
| Rate for Payer: Kentucky WC Medicaid |
$27.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.18
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
SENSITIVI DISK METH PER PLA G
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
30001319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$10.47 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.48
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Humana Medicare Advantage |
$7.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.48
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
SENSITIVI DISK METH PER PLA G
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
30001319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.42
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.48
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Professional
|
Both
|
$76.23
|
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.68 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Buckeye Medicare Advantage |
$76.23
|
| Rate for Payer: Cash Price |
$38.12
|
| Rate for Payer: Multiplan PHCS |
$45.74
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.36
|
| Rate for Payer: UHCCP Medicaid |
$26.68
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
OP
|
$76.23
|
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$73.18 |
| Rate for Payer: Aetna Commercial |
$58.70
|
| Rate for Payer: Anthem Medicaid |
$26.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.46
|
| Rate for Payer: Cash Price |
$38.12
|
| Rate for Payer: Cigna Commercial |
$63.27
|
| Rate for Payer: First Health Commercial |
$72.42
|
| Rate for Payer: Humana Commercial |
$64.80
|
| Rate for Payer: Humana KY Medicaid |
$26.22
|
| Rate for Payer: Kentucky WC Medicaid |
$26.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.08
|
| Rate for Payer: Ohio Health Group HMO |
$57.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.63
|
| Rate for Payer: PHCS Commercial |
$73.18
|
| Rate for Payer: United Healthcare All Payer |
$67.08
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
IP
|
$79.23
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$76.06 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.80
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Cigna Commercial |
$65.76
|
| Rate for Payer: First Health Commercial |
$75.27
|
| Rate for Payer: Humana Commercial |
$67.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.72
|
| Rate for Payer: Ohio Health Group HMO |
$59.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.56
|
| Rate for Payer: PHCS Commercial |
$76.06
|
| Rate for Payer: United Healthcare All Payer |
$69.72
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
OP
|
$76.23
|
|
| Hospital Charge Code |
636T0093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$73.18 |
| Rate for Payer: Aetna Commercial |
$58.70
|
| Rate for Payer: Anthem Medicaid |
$26.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.46
|
| Rate for Payer: Cash Price |
$38.12
|
| Rate for Payer: Cigna Commercial |
$63.27
|
| Rate for Payer: First Health Commercial |
$72.42
|
| Rate for Payer: Humana Commercial |
$64.80
|
| Rate for Payer: Humana KY Medicaid |
$26.22
|
| Rate for Payer: Kentucky WC Medicaid |
$26.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.08
|
| Rate for Payer: Ohio Health Group HMO |
$57.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.63
|
| Rate for Payer: PHCS Commercial |
$73.18
|
| Rate for Payer: United Healthcare All Payer |
$67.08
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
IP
|
$76.23
|
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$73.18 |
| Rate for Payer: Aetna Commercial |
$58.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.46
|
| Rate for Payer: Cash Price |
$38.12
|
| Rate for Payer: Cigna Commercial |
$63.27
|
| Rate for Payer: First Health Commercial |
$72.42
|
| Rate for Payer: Humana Commercial |
$64.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.08
|
| Rate for Payer: Ohio Health Group HMO |
$57.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.63
|
| Rate for Payer: PHCS Commercial |
$73.18
|
| Rate for Payer: United Healthcare All Payer |
$67.08
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
IP
|
$76.23
|
|
| Hospital Charge Code |
636T0093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$73.18 |
| Rate for Payer: Aetna Commercial |
$58.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.46
|
| Rate for Payer: Cash Price |
$38.12
|
| Rate for Payer: Cigna Commercial |
$63.27
|
| Rate for Payer: First Health Commercial |
$72.42
|
| Rate for Payer: Humana Commercial |
$64.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.08
|
| Rate for Payer: Ohio Health Group HMO |
$57.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.63
|
| Rate for Payer: PHCS Commercial |
$73.18
|
| Rate for Payer: United Healthcare All Payer |
$67.08
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
OP
|
$79.23
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$76.06 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Anthem Medicaid |
$27.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Cigna Commercial |
$65.76
|
| Rate for Payer: First Health Commercial |
$75.27
|
| Rate for Payer: Humana Commercial |
$67.35
|
| Rate for Payer: Humana KY Medicaid |
$27.25
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$27.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.72
|
| Rate for Payer: Ohio Health Group HMO |
$59.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.56
|
| Rate for Payer: PHCS Commercial |
$76.06
|
| Rate for Payer: United Healthcare All Payer |
$69.72
|
|
|
SENSORCAINE MPF/EPI 0.5% 10ML
|
Facility
|
IP
|
$78.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003440
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$75.50 |
| Rate for Payer: Aetna Commercial |
$60.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Cash Price |
$39.33
|
| Rate for Payer: Cigna Commercial |
$65.28
|
| Rate for Payer: First Health Commercial |
$74.72
|
| Rate for Payer: Humana Commercial |
$66.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.21
|
| Rate for Payer: Ohio Health Group HMO |
$58.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.38
|
| Rate for Payer: PHCS Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Payer |
$69.21
|
|
|
SENSORCAINE MPF/EPI 0.5% 10ML
|
Facility
|
OP
|
$78.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003440
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$75.50 |
| Rate for Payer: Aetna Commercial |
$60.56
|
| Rate for Payer: Anthem Medicaid |
$27.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Cash Price |
$39.33
|
| Rate for Payer: Cigna Commercial |
$65.28
|
| Rate for Payer: First Health Commercial |
$74.72
|
| Rate for Payer: Humana Commercial |
$66.85
|
| Rate for Payer: Humana KY Medicaid |
$27.05
|
| Rate for Payer: Kentucky WC Medicaid |
$27.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.21
|
| Rate for Payer: Ohio Health Group HMO |
$58.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.38
|
| Rate for Payer: PHCS Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Payer |
$69.21
|
|
|
SENTINAL NODE NAV GEN
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
SENTINAL NODE NAV GEN
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
SENTINOL NODE INJECT MELANO (P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
340P0118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$116.21 |
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$22.63
|
| Rate for Payer: Anthem Medicaid |
$113.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$55.97
|
| Rate for Payer: Healthspan PPO |
$47.96
|
| Rate for Payer: Humana Medicaid |
$113.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.21
|
| Rate for Payer: Molina Healthcare Passport |
$113.93
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$23.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.07
|
|
|
SENTINOL NODE INJECT MELANO (T
|
Facility
|
IP
|
$1,257.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
340T0118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$163.41 |
| Max. Negotiated Rate |
$1,206.72 |
| Rate for Payer: Aetna Commercial |
$967.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$980.46
|
| Rate for Payer: Cash Price |
$628.50
|
| Rate for Payer: Cigna Commercial |
$1,043.31
|
| Rate for Payer: First Health Commercial |
$1,194.15
|
| Rate for Payer: Humana Commercial |
$1,068.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,030.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$927.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$377.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,106.16
|
| Rate for Payer: Ohio Health Group HMO |
$942.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.67
|
| Rate for Payer: PHCS Commercial |
$1,206.72
|
| Rate for Payer: United Healthcare All Payer |
$1,106.16
|
|
|
SENTINOL NODE INJECT MELANO (T
|
Facility
|
OP
|
$1,257.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
340T0118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$163.41 |
| Max. Negotiated Rate |
$1,206.72 |
| Rate for Payer: Aetna Commercial |
$967.89
|
| Rate for Payer: Anthem Medicaid |
$432.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$980.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$628.50
|
| Rate for Payer: Cash Price |
$628.50
|
| Rate for Payer: Cigna Commercial |
$1,043.31
|
| Rate for Payer: First Health Commercial |
$1,194.15
|
| Rate for Payer: Humana Commercial |
$1,068.45
|
| Rate for Payer: Humana KY Medicaid |
$432.28
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$436.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,030.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$927.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$440.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,106.16
|
| Rate for Payer: Ohio Health Group HMO |
$942.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.67
|
| Rate for Payer: PHCS Commercial |
$1,206.72
|
| Rate for Payer: United Healthcare All Payer |
$1,106.16
|
|
|
SENTRANT INTRODUCER SHEATH 12*
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
SENTRANT INTRODUCER SHEATH 12*
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
SENTRANT INTRODUCER SHEATH 14*
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SENTRANT INTRODUCER SHEATH 14*
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SENTRANT INTRODUCER SHEATH 16*
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SENTRANT INTRODUCER SHEATH 16*
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SENTRY IVC FILTER
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
