|
SHAVE LSN FEENL OVER 2.0 CM(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
761P0050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.49 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.49
|
| Rate for Payer: Anthem Medicaid |
$71.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$196.63
|
| Rate for Payer: Healthspan PPO |
$170.34
|
| Rate for Payer: Humana Medicaid |
$71.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.58
|
| Rate for Payer: Molina Healthcare Passport |
$71.16
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$69.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.87
|
|
|
SHAVE LSN FEENL OVER 2.0 CM(T
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
761T0050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
SHAVE LSN FEENL OVER 2.0 CM(T
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
761T0050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem Medicaid |
$183.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Humana KY Medicaid |
$183.64
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$185.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
761T0047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem Medicaid |
$93.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Humana KY Medicaid |
$93.54
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$94.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.36 |
| Max. Negotiated Rate |
$453.12 |
| Rate for Payer: Aetna Commercial |
$363.44
|
| Rate for Payer: Anthem Medicaid |
$162.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$391.76
|
| Rate for Payer: First Health Commercial |
$448.40
|
| Rate for Payer: Humana Commercial |
$401.20
|
| Rate for Payer: Humana KY Medicaid |
$162.32
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$163.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$348.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$415.36
|
| Rate for Payer: Ohio Health Group HMO |
$354.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.32
|
| Rate for Payer: PHCS Commercial |
$453.12
|
| Rate for Payer: United Healthcare All Payer |
$415.36
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Aetna Commercial |
$62.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.60
|
| Rate for Payer: Anthem Medicaid |
$32.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$472.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$106.30
|
| Rate for Payer: Healthspan PPO |
$92.03
|
| Rate for Payer: Humana Medicaid |
$32.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.77
|
| Rate for Payer: Molina Healthcare Passport |
$32.13
|
| Rate for Payer: Multiplan PHCS |
$283.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$330.40
|
| Rate for Payer: UHCCP Medicaid |
$39.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.45
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
761P0047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$62.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.60
|
| Rate for Payer: Anthem Medicaid |
$32.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$106.30
|
| Rate for Payer: Healthspan PPO |
$92.03
|
| Rate for Payer: Humana Medicaid |
$32.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.77
|
| Rate for Payer: Molina Healthcare Passport |
$32.13
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$39.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.45
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
761T0047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.36 |
| Max. Negotiated Rate |
$453.12 |
| Rate for Payer: Aetna Commercial |
$363.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.16
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$391.76
|
| Rate for Payer: First Health Commercial |
$448.40
|
| Rate for Payer: Humana Commercial |
$401.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$348.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$415.36
|
| Rate for Payer: Ohio Health Group HMO |
$354.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.32
|
| Rate for Payer: PHCS Commercial |
$453.12
|
| Rate for Payer: United Healthcare All Payer |
$415.36
|
|
|
SHEATH 20F 25CM
|
Facility
|
OP
|
$3,715.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.02 |
| Max. Negotiated Rate |
$3,566.88 |
| Rate for Payer: Aetna Commercial |
$2,860.94
|
| Rate for Payer: Anthem Medicaid |
$1,277.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,898.09
|
| Rate for Payer: Cash Price |
$1,857.75
|
| Rate for Payer: Cigna Commercial |
$3,083.86
|
| Rate for Payer: First Health Commercial |
$3,529.72
|
| Rate for Payer: Humana Commercial |
$3,158.18
|
| Rate for Payer: Humana KY Medicaid |
$1,277.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,290.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,046.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,742.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,114.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,303.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,269.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,786.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,151.80
|
| Rate for Payer: PHCS Commercial |
$3,566.88
|
| Rate for Payer: United Healthcare All Payer |
$3,269.64
|
|
|
SHEATH 20F 25CM
|
Facility
|
IP
|
$3,715.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.02 |
| Max. Negotiated Rate |
$3,566.88 |
| Rate for Payer: Aetna Commercial |
$2,860.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,898.09
|
| Rate for Payer: Cash Price |
$1,857.75
|
| Rate for Payer: Cigna Commercial |
$3,083.86
|
| Rate for Payer: First Health Commercial |
$3,529.72
|
| Rate for Payer: Humana Commercial |
$3,158.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,046.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,742.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,114.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,269.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,786.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,151.80
|
| Rate for Payer: PHCS Commercial |
$3,566.88
|
| Rate for Payer: United Healthcare All Payer |
$3,269.64
|
|
|
SHEATH 24F 25CM
|
Facility
|
IP
|
$3,761.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.93 |
| Max. Negotiated Rate |
$3,610.56 |
| Rate for Payer: Aetna Commercial |
$2,895.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,933.58
|
| Rate for Payer: Cash Price |
$1,880.50
|
| Rate for Payer: Cigna Commercial |
$3,121.63
|
| Rate for Payer: First Health Commercial |
$3,572.95
|
| Rate for Payer: Humana Commercial |
$3,196.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,084.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,775.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,309.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,820.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,165.91
|
| Rate for Payer: PHCS Commercial |
$3,610.56
|
| Rate for Payer: United Healthcare All Payer |
$3,309.68
|
|
|
SHEATH 24F 25CM
|
Facility
|
OP
|
$3,761.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.93 |
| Max. Negotiated Rate |
$3,610.56 |
| Rate for Payer: Aetna Commercial |
$2,895.97
|
| Rate for Payer: Anthem Medicaid |
$1,293.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,933.58
|
| Rate for Payer: Cash Price |
$1,880.50
|
| Rate for Payer: Cigna Commercial |
$3,121.63
|
| Rate for Payer: First Health Commercial |
$3,572.95
|
| Rate for Payer: Humana Commercial |
$3,196.85
|
| Rate for Payer: Humana KY Medicaid |
$1,293.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,306.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,084.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,775.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,319.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,309.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,820.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,165.91
|
| Rate for Payer: PHCS Commercial |
$3,610.56
|
| Rate for Payer: United Healthcare All Payer |
$3,309.68
|
|
|
SHEATH 5FR
|
Facility
|
IP
|
$484.14
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.94 |
| Max. Negotiated Rate |
$464.77 |
| Rate for Payer: Aetna Commercial |
$372.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.63
|
| Rate for Payer: Cash Price |
$242.07
|
| Rate for Payer: Cigna Commercial |
$401.84
|
| Rate for Payer: First Health Commercial |
$459.93
|
| Rate for Payer: Humana Commercial |
$411.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$426.04
|
| Rate for Payer: Ohio Health Group HMO |
$363.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.08
|
| Rate for Payer: PHCS Commercial |
$464.77
|
| Rate for Payer: United Healthcare All Payer |
$426.04
|
|
|
SHEATH 5FR
|
Facility
|
OP
|
$484.14
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.94 |
| Max. Negotiated Rate |
$464.77 |
| Rate for Payer: Aetna Commercial |
$372.79
|
| Rate for Payer: Anthem Medicaid |
$166.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.63
|
| Rate for Payer: Cash Price |
$242.07
|
| Rate for Payer: Cigna Commercial |
$401.84
|
| Rate for Payer: First Health Commercial |
$459.93
|
| Rate for Payer: Humana Commercial |
$411.52
|
| Rate for Payer: Humana KY Medicaid |
$166.50
|
| Rate for Payer: Kentucky WC Medicaid |
$168.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$426.04
|
| Rate for Payer: Ohio Health Group HMO |
$363.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.08
|
| Rate for Payer: PHCS Commercial |
$464.77
|
| Rate for Payer: United Healthcare All Payer |
$426.04
|
|
|
SHEATH 8 FR 353893
|
Facility
|
IP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
SHEATH 8 FR 353893
|
Facility
|
OP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem Medicaid |
$388.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Humana KY Medicaid |
$388.44
|
| Rate for Payer: Kentucky WC Medicaid |
$392.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
SHEATH ADAPTER W/SHIELD
|
Facility
|
IP
|
$522.33
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$501.44 |
| Rate for Payer: Aetna Commercial |
$402.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.42
|
| Rate for Payer: Cash Price |
$261.17
|
| Rate for Payer: Cigna Commercial |
$433.53
|
| Rate for Payer: First Health Commercial |
$496.21
|
| Rate for Payer: Humana Commercial |
$443.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$428.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$385.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$459.65
|
| Rate for Payer: Ohio Health Group HMO |
$391.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.92
|
| Rate for Payer: PHCS Commercial |
$501.44
|
| Rate for Payer: United Healthcare All Payer |
$459.65
|
|
|
SHEATH ADAPTER W/SHIELD
|
Facility
|
OP
|
$522.33
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$501.44 |
| Rate for Payer: Aetna Commercial |
$402.19
|
| Rate for Payer: Anthem Medicaid |
$179.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.42
|
| Rate for Payer: Cash Price |
$261.17
|
| Rate for Payer: Cigna Commercial |
$433.53
|
| Rate for Payer: First Health Commercial |
$496.21
|
| Rate for Payer: Humana Commercial |
$443.98
|
| Rate for Payer: Humana KY Medicaid |
$179.63
|
| Rate for Payer: Kentucky WC Medicaid |
$181.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$428.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$385.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$183.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$459.65
|
| Rate for Payer: Ohio Health Group HMO |
$391.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.92
|
| Rate for Payer: PHCS Commercial |
$501.44
|
| Rate for Payer: United Healthcare All Payer |
$459.65
|
|
|
SHEATH AMPLATZ RENAL 24FR
|
Facility
|
OP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem Medicaid |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Humana KY Medicaid |
$266.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
SHEATH AMPLATZ RENAL 24FR
|
Facility
|
IP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
SHEATH AMPLATZ RENAL 28FR
|
Facility
|
OP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem Medicaid |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Humana KY Medicaid |
$266.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
SHEATH AMPLATZ RENAL 28FR
|
Facility
|
IP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
SHEATH AMPLATZ RENAL 30FR
|
Facility
|
IP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
|
SHEATH AMPLATZ RENAL 30FR
|
Facility
|
OP
|
$774.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$743.18 |
| Rate for Payer: Aetna Commercial |
$596.10
|
| Rate for Payer: Anthem Medicaid |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.84
|
| Rate for Payer: Cash Price |
$387.08
|
| Rate for Payer: Cigna Commercial |
$642.54
|
| Rate for Payer: First Health Commercial |
$735.44
|
| Rate for Payer: Humana Commercial |
$658.03
|
| Rate for Payer: Humana KY Medicaid |
$266.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.25
|
| Rate for Payer: Ohio Health Group HMO |
$580.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.99
|
| Rate for Payer: PHCS Commercial |
$743.18
|
| Rate for Payer: United Healthcare All Payer |
$681.25
|
|
