|
SHEATH INNER
|
Facility
|
OP
|
$4,555.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.22 |
| Max. Negotiated Rate |
$4,373.28 |
| Rate for Payer: Aetna Commercial |
$3,507.74
|
| Rate for Payer: Anthem Medicaid |
$1,566.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,553.29
|
| Rate for Payer: Cash Price |
$2,277.75
|
| Rate for Payer: Cigna Commercial |
$3,781.06
|
| Rate for Payer: First Health Commercial |
$4,327.72
|
| Rate for Payer: Humana Commercial |
$3,872.18
|
| Rate for Payer: Humana KY Medicaid |
$1,566.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,582.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,735.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,361.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,366.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,598.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,008.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,416.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$911.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,412.20
|
| Rate for Payer: PHCS Commercial |
$4,373.28
|
| Rate for Payer: United Healthcare All Payer |
$4,008.84
|
|
|
SHEATH INNER
|
Facility
|
IP
|
$4,555.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.22 |
| Max. Negotiated Rate |
$4,373.28 |
| Rate for Payer: Aetna Commercial |
$3,507.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,553.29
|
| Rate for Payer: Cash Price |
$2,277.75
|
| Rate for Payer: Cigna Commercial |
$3,781.06
|
| Rate for Payer: First Health Commercial |
$4,327.72
|
| Rate for Payer: Humana Commercial |
$3,872.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,735.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,361.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,366.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,008.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,416.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$911.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,412.20
|
| Rate for Payer: PHCS Commercial |
$4,373.28
|
| Rate for Payer: United Healthcare All Payer |
$4,008.84
|
|
|
SHEATH INTERVENTIONAL #8
|
Facility
|
OP
|
$746.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Aetna Commercial |
$574.61
|
| Rate for Payer: Anthem Medicaid |
$256.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$582.08
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Cigna Commercial |
$619.39
|
| Rate for Payer: First Health Commercial |
$708.94
|
| Rate for Payer: Humana Commercial |
$634.31
|
| Rate for Payer: Humana KY Medicaid |
$256.64
|
| Rate for Payer: Kentucky WC Medicaid |
$259.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.70
|
| Rate for Payer: Ohio Health Group HMO |
$559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.34
|
| Rate for Payer: PHCS Commercial |
$716.40
|
| Rate for Payer: United Healthcare All Payer |
$656.70
|
|
|
SHEATH INTERVENTIONAL #8
|
Facility
|
IP
|
$746.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Aetna Commercial |
$574.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$582.08
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Cigna Commercial |
$619.39
|
| Rate for Payer: First Health Commercial |
$708.94
|
| Rate for Payer: Humana Commercial |
$634.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.70
|
| Rate for Payer: Ohio Health Group HMO |
$559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.34
|
| Rate for Payer: PHCS Commercial |
$716.40
|
| Rate for Payer: United Healthcare All Payer |
$656.70
|
|
|
SHEATH INTRO 6.5FR
|
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
|
|
|
SHEATH INTRO 6.5FR
|
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
|
|
|
SHEATH INTRODUCER CLASSIC 6FR
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
SHEATH INTRODUCER CLASSIC 6FR
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
SHEATH INTRODUCER DEVICE 17FR
|
Facility
|
IP
|
$3,946.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$513.04 |
| Max. Negotiated Rate |
$3,788.64 |
| Rate for Payer: Aetna Commercial |
$3,038.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,078.27
|
| Rate for Payer: Cash Price |
$1,973.25
|
| Rate for Payer: Cigna Commercial |
$3,275.60
|
| Rate for Payer: First Health Commercial |
$3,749.18
|
| Rate for Payer: Humana Commercial |
$3,354.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,236.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,912.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,472.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,959.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$789.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,223.42
|
| Rate for Payer: PHCS Commercial |
$3,788.64
|
| Rate for Payer: United Healthcare All Payer |
$3,472.92
|
|
|
SHEATH INTRODUCER DEVICE 17FR
|
Facility
|
OP
|
$3,946.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$513.04 |
| Max. Negotiated Rate |
$3,788.64 |
| Rate for Payer: Aetna Commercial |
$3,038.80
|
| Rate for Payer: Anthem Medicaid |
$1,357.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,078.27
|
| Rate for Payer: Cash Price |
$1,973.25
|
| Rate for Payer: Cigna Commercial |
$3,275.60
|
| Rate for Payer: First Health Commercial |
$3,749.18
|
| Rate for Payer: Humana Commercial |
$3,354.52
|
| Rate for Payer: Humana KY Medicaid |
$1,357.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,371.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,236.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,912.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,384.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,472.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,959.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$789.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,223.42
|
| Rate for Payer: PHCS Commercial |
$3,788.64
|
| Rate for Payer: United Healthcare All Payer |
$3,472.92
|
|
|
SHEATH MERIT PRELUDE 6FR 13CM
|
Facility
|
IP
|
$1,519.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.54 |
| Max. Negotiated Rate |
$1,458.72 |
| Rate for Payer: Aetna Commercial |
$1,170.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.21
|
| Rate for Payer: Cash Price |
$759.75
|
| Rate for Payer: Cigna Commercial |
$1,261.18
|
| Rate for Payer: First Health Commercial |
$1,443.52
|
| Rate for Payer: Humana Commercial |
$1,291.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.04
|
| Rate for Payer: PHCS Commercial |
$1,458.72
|
| Rate for Payer: United Healthcare All Payer |
$1,337.16
|
|
|
SHEATH MERIT PRELUDE 6FR 13CM
|
Facility
|
OP
|
$1,519.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.54 |
| Max. Negotiated Rate |
$1,458.72 |
| Rate for Payer: Aetna Commercial |
$1,170.02
|
| Rate for Payer: Anthem Medicaid |
$522.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.21
|
| Rate for Payer: Cash Price |
$759.75
|
| Rate for Payer: Cigna Commercial |
$1,261.18
|
| Rate for Payer: First Health Commercial |
$1,443.52
|
| Rate for Payer: Humana Commercial |
$1,291.58
|
| Rate for Payer: Humana KY Medicaid |
$522.56
|
| Rate for Payer: Kentucky WC Medicaid |
$527.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.04
|
| Rate for Payer: PHCS Commercial |
$1,458.72
|
| Rate for Payer: United Healthcare All Payer |
$1,337.16
|
|
|
SHEATH MERIT PRELUDE 8FR 13CM
|
Facility
|
IP
|
$1,519.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.54 |
| Max. Negotiated Rate |
$1,458.72 |
| Rate for Payer: Aetna Commercial |
$1,170.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.21
|
| Rate for Payer: Cash Price |
$759.75
|
| Rate for Payer: Cigna Commercial |
$1,261.18
|
| Rate for Payer: First Health Commercial |
$1,443.52
|
| Rate for Payer: Humana Commercial |
$1,291.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.04
|
| Rate for Payer: PHCS Commercial |
$1,458.72
|
| Rate for Payer: United Healthcare All Payer |
$1,337.16
|
|
|
SHEATH MERIT PRELUDE 8FR 13CM
|
Facility
|
OP
|
$1,519.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.54 |
| Max. Negotiated Rate |
$1,458.72 |
| Rate for Payer: Aetna Commercial |
$1,170.02
|
| Rate for Payer: Anthem Medicaid |
$522.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.21
|
| Rate for Payer: Cash Price |
$759.75
|
| Rate for Payer: Cigna Commercial |
$1,261.18
|
| Rate for Payer: First Health Commercial |
$1,443.52
|
| Rate for Payer: Humana Commercial |
$1,291.58
|
| Rate for Payer: Humana KY Medicaid |
$522.56
|
| Rate for Payer: Kentucky WC Medicaid |
$527.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.04
|
| Rate for Payer: PHCS Commercial |
$1,458.72
|
| Rate for Payer: United Healthcare All Payer |
$1,337.16
|
|
|
SHEATH NAVIGATOR 13/15 F*36CM
|
Facility
|
IP
|
$4,066.48
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$528.64 |
| Max. Negotiated Rate |
$3,903.82 |
| Rate for Payer: Aetna Commercial |
$3,131.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,171.85
|
| Rate for Payer: Cash Price |
$2,033.24
|
| Rate for Payer: Cigna Commercial |
$3,375.18
|
| Rate for Payer: First Health Commercial |
$3,863.16
|
| Rate for Payer: Humana Commercial |
$3,456.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,001.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,049.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$813.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$528.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,260.61
|
| Rate for Payer: PHCS Commercial |
$3,903.82
|
| Rate for Payer: United Healthcare All Payer |
$3,578.50
|
|
|
SHEATH NAVIGATOR 13/15 F*36CM
|
Facility
|
OP
|
$4,066.48
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$528.64 |
| Max. Negotiated Rate |
$3,903.82 |
| Rate for Payer: Aetna Commercial |
$3,131.19
|
| Rate for Payer: Anthem Medicaid |
$1,398.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,171.85
|
| Rate for Payer: Cash Price |
$2,033.24
|
| Rate for Payer: Cigna Commercial |
$3,375.18
|
| Rate for Payer: First Health Commercial |
$3,863.16
|
| Rate for Payer: Humana Commercial |
$3,456.51
|
| Rate for Payer: Humana KY Medicaid |
$1,398.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,412.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,001.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,426.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,049.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$813.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$528.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,260.61
|
| Rate for Payer: PHCS Commercial |
$3,903.82
|
| Rate for Payer: United Healthcare All Payer |
$3,578.50
|
|
|
SHEATH PINNACLE 9FR
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
SHEATH PINNACLE 9FR
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
SHEATH PINNACLE DEST 6FR ST
|
Facility
|
IP
|
$1,591.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.86 |
| Max. Negotiated Rate |
$1,527.60 |
| Rate for Payer: Aetna Commercial |
$1,225.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,241.18
|
| Rate for Payer: Cash Price |
$795.62
|
| Rate for Payer: Cigna Commercial |
$1,320.74
|
| Rate for Payer: First Health Commercial |
$1,511.69
|
| Rate for Payer: Humana Commercial |
$1,352.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,304.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,174.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,400.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,193.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.29
|
| Rate for Payer: PHCS Commercial |
$1,527.60
|
| Rate for Payer: United Healthcare All Payer |
$1,400.30
|
|
|
SHEATH PINNACLE DEST 6FR ST
|
Facility
|
OP
|
$1,591.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.86 |
| Max. Negotiated Rate |
$1,527.60 |
| Rate for Payer: Aetna Commercial |
$1,225.26
|
| Rate for Payer: Anthem Medicaid |
$547.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,241.18
|
| Rate for Payer: Cash Price |
$795.62
|
| Rate for Payer: Cigna Commercial |
$1,320.74
|
| Rate for Payer: First Health Commercial |
$1,511.69
|
| Rate for Payer: Humana Commercial |
$1,352.56
|
| Rate for Payer: Humana KY Medicaid |
$547.23
|
| Rate for Payer: Kentucky WC Medicaid |
$552.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,304.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,174.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$558.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,400.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,193.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.29
|
| Rate for Payer: PHCS Commercial |
$1,527.60
|
| Rate for Payer: United Healthcare All Payer |
$1,400.30
|
|
|
SHEATH PINNACLE DEST 7FR ST
|
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
|
|
|
SHEATH PINNACLE DEST 7FR ST
|
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
|
|
|
SHEATH TUN DISP SCANLAN SM
|
Facility
|
OP
|
$1,110.92
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.42 |
| Max. Negotiated Rate |
$1,066.48 |
| Rate for Payer: Aetna Commercial |
$855.41
|
| Rate for Payer: Anthem Medicaid |
$382.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$866.52
|
| Rate for Payer: Cash Price |
$555.46
|
| Rate for Payer: Cigna Commercial |
$922.06
|
| Rate for Payer: First Health Commercial |
$1,055.37
|
| Rate for Payer: Humana Commercial |
$944.28
|
| Rate for Payer: Humana KY Medicaid |
$382.05
|
| Rate for Payer: Kentucky WC Medicaid |
$385.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$910.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$819.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$389.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$977.61
|
| Rate for Payer: Ohio Health Group HMO |
$833.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.39
|
| Rate for Payer: PHCS Commercial |
$1,066.48
|
| Rate for Payer: United Healthcare All Payer |
$977.61
|
|
|
SHEATH TUN DISP SCANLAN SM
|
Facility
|
IP
|
$1,110.92
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.42 |
| Max. Negotiated Rate |
$1,066.48 |
| Rate for Payer: Aetna Commercial |
$855.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$866.52
|
| Rate for Payer: Cash Price |
$555.46
|
| Rate for Payer: Cigna Commercial |
$922.06
|
| Rate for Payer: First Health Commercial |
$1,055.37
|
| Rate for Payer: Humana Commercial |
$944.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$910.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$819.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$977.61
|
| Rate for Payer: Ohio Health Group HMO |
$833.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.39
|
| Rate for Payer: PHCS Commercial |
$1,066.48
|
| Rate for Payer: United Healthcare All Payer |
$977.61
|
|
|
SHEATH W/GW 6FR*10CM*.038
|
Facility
|
IP
|
$163.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Aetna Commercial |
$125.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.23
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cigna Commercial |
$135.39
|
| Rate for Payer: First Health Commercial |
$154.96
|
| Rate for Payer: Humana Commercial |
$138.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.55
|
| Rate for Payer: Ohio Health Group HMO |
$122.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.57
|
| Rate for Payer: PHCS Commercial |
$156.60
|
| Rate for Payer: United Healthcare All Payer |
$143.55
|
|
