|
SENTRANT INTRO SHEATH 12*28
|
Facility
|
OP
|
$1,904.20
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,828.03 |
| Rate for Payer: Aetna Commercial |
$1,466.23
|
| Rate for Payer: Anthem Medicaid |
$654.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.28
|
| Rate for Payer: Cash Price |
$952.10
|
| Rate for Payer: Cigna Commercial |
$1,580.49
|
| Rate for Payer: First Health Commercial |
$1,808.99
|
| Rate for Payer: Humana Commercial |
$1,618.57
|
| Rate for Payer: Humana KY Medicaid |
$654.85
|
| Rate for Payer: Kentucky WC Medicaid |
$661.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,561.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,675.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,656.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,313.90
|
| Rate for Payer: PHCS Commercial |
$1,828.03
|
| Rate for Payer: United Healthcare All Payer |
$1,675.70
|
|
|
SENTRANT INTRO SHEATH 12*28
|
Facility
|
IP
|
$1,904.20
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,828.03 |
| Rate for Payer: Aetna Commercial |
$1,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.28
|
| Rate for Payer: Cash Price |
$952.10
|
| Rate for Payer: Cigna Commercial |
$1,580.49
|
| Rate for Payer: First Health Commercial |
$1,808.99
|
| Rate for Payer: Humana Commercial |
$1,618.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,561.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,675.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,656.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,313.90
|
| Rate for Payer: PHCS Commercial |
$1,828.03
|
| Rate for Payer: United Healthcare All Payer |
$1,675.70
|
|
|
SENTRANT INTRO SHEATH 14*28
|
Facility
|
IP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
SENTRANT INTRO SHEATH 14*28
|
Facility
|
OP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem Medicaid |
$724.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Humana KY Medicaid |
$724.12
|
| Rate for Payer: Kentucky WC Medicaid |
$731.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
SENTRANT INTRO SHEATH 16*28
|
Facility
|
IP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
SENTRANT INTRO SHEATH 16*28
|
Facility
|
OP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem Medicaid |
$724.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Humana KY Medicaid |
$724.12
|
| Rate for Payer: Kentucky WC Medicaid |
$731.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
SENTRANT INTRO SHEATH 18*28
|
Facility
|
OP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem Medicaid |
$724.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Humana KY Medicaid |
$724.12
|
| Rate for Payer: Kentucky WC Medicaid |
$731.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
SENTRANT INTRO SHEATH 18*28
|
Facility
|
IP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
SENTRANT INTRO SHEATH 20*28
|
Facility
|
OP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem Medicaid |
$1,029.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Humana KY Medicaid |
$1,029.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,050.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
SENTRANT INTRO SHEATH 20*28
|
Facility
|
IP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
SENTRANT INTRO SHEATH 22*28
|
Facility
|
OP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem Medicaid |
$1,029.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Humana KY Medicaid |
$1,029.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,050.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
SENTRANT INTRO SHEATH 22*28
|
Facility
|
IP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
SENTRANT INTRO SHEATH 24*28
|
Facility
|
OP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem Medicaid |
$1,029.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Humana KY Medicaid |
$1,029.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,050.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
SENTRANT INTRO SHEATH 24*28
|
Facility
|
IP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
SENTRANT INTRO SHEATH 26*28
|
Facility
|
OP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem Medicaid |
$1,029.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Humana KY Medicaid |
$1,029.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,050.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
SENTRANT INTRO SHEATH 26*28
|
Facility
|
IP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
SENTRY IVC FILTER
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
SENTRY IVC FILTER
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
SEPARATOR 12
|
Facility
|
IP
|
$10,099.25
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,029.78 |
| Max. Negotiated Rate |
$9,695.28 |
| Rate for Payer: Aetna Commercial |
$7,776.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,877.41
|
| Rate for Payer: Cash Price |
$5,049.62
|
| Rate for Payer: Cigna Commercial |
$8,382.38
|
| Rate for Payer: First Health Commercial |
$9,594.29
|
| Rate for Payer: Humana Commercial |
$8,584.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,281.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,453.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,029.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,887.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,574.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,079.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,786.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,968.48
|
| Rate for Payer: PHCS Commercial |
$9,695.28
|
| Rate for Payer: United Healthcare All Payer |
$8,887.34
|
|
|
SEPARATOR 12
|
Facility
|
OP
|
$10,099.25
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,029.78 |
| Max. Negotiated Rate |
$9,695.28 |
| Rate for Payer: Aetna Commercial |
$7,776.42
|
| Rate for Payer: Anthem Medicaid |
$3,473.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,877.41
|
| Rate for Payer: Cash Price |
$5,049.62
|
| Rate for Payer: Cigna Commercial |
$8,382.38
|
| Rate for Payer: First Health Commercial |
$9,594.29
|
| Rate for Payer: Humana Commercial |
$8,584.36
|
| Rate for Payer: Humana KY Medicaid |
$3,473.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,508.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,281.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,453.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,029.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,542.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,887.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,574.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,079.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,786.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,968.48
|
| Rate for Payer: PHCS Commercial |
$9,695.28
|
| Rate for Payer: United Healthcare All Payer |
$8,887.34
|
|
|
SEPARATOR 3
|
Facility
|
OP
|
$4,681.25
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,404.38 |
| Max. Negotiated Rate |
$4,494.00 |
| Rate for Payer: Aetna Commercial |
$3,604.56
|
| Rate for Payer: Anthem Medicaid |
$1,609.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,651.38
|
| Rate for Payer: Cash Price |
$2,340.62
|
| Rate for Payer: Cigna Commercial |
$3,885.44
|
| Rate for Payer: First Health Commercial |
$4,447.19
|
| Rate for Payer: Humana Commercial |
$3,979.06
|
| Rate for Payer: Humana KY Medicaid |
$1,609.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,626.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,838.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,454.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,404.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,642.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,119.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,510.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,745.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,072.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,230.06
|
| Rate for Payer: PHCS Commercial |
$4,494.00
|
| Rate for Payer: United Healthcare All Payer |
$4,119.50
|
|
|
SEPARATOR 3
|
Facility
|
IP
|
$4,681.25
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,404.38 |
| Max. Negotiated Rate |
$4,494.00 |
| Rate for Payer: Aetna Commercial |
$3,604.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,651.38
|
| Rate for Payer: Cash Price |
$2,340.62
|
| Rate for Payer: Cigna Commercial |
$3,885.44
|
| Rate for Payer: First Health Commercial |
$4,447.19
|
| Rate for Payer: Humana Commercial |
$3,979.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,838.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,454.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,404.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,119.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,510.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,745.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,072.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,230.06
|
| Rate for Payer: PHCS Commercial |
$4,494.00
|
| Rate for Payer: United Healthcare All Payer |
$4,119.50
|
|
|
SEPARATOR 4
|
Facility
|
OP
|
$5,300.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$5,088.00 |
| Rate for Payer: Aetna Commercial |
$4,081.00
|
| Rate for Payer: Anthem Medicaid |
$1,822.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,650.00
|
| Rate for Payer: Cigna Commercial |
$4,399.00
|
| Rate for Payer: First Health Commercial |
$5,035.00
|
| Rate for Payer: Humana Commercial |
$4,505.00
|
| Rate for Payer: Humana KY Medicaid |
$1,822.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,841.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,346.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,911.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,664.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,611.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,657.00
|
| Rate for Payer: PHCS Commercial |
$5,088.00
|
| Rate for Payer: United Healthcare All Payer |
$4,664.00
|
|
|
SEPARATOR 4
|
Facility
|
IP
|
$5,300.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$5,088.00 |
| Rate for Payer: Aetna Commercial |
$4,081.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,650.00
|
| Rate for Payer: Cigna Commercial |
$4,399.00
|
| Rate for Payer: First Health Commercial |
$5,035.00
|
| Rate for Payer: Humana Commercial |
$4,505.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,346.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,911.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,664.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,611.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,657.00
|
| Rate for Payer: PHCS Commercial |
$5,088.00
|
| Rate for Payer: United Healthcare All Payer |
$4,664.00
|
|
|
SEPARATOR 5
|
Facility
|
IP
|
$4,681.25
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,404.38 |
| Max. Negotiated Rate |
$4,494.00 |
| Rate for Payer: Aetna Commercial |
$3,604.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,651.38
|
| Rate for Payer: Cash Price |
$2,340.62
|
| Rate for Payer: Cigna Commercial |
$3,885.44
|
| Rate for Payer: First Health Commercial |
$4,447.19
|
| Rate for Payer: Humana Commercial |
$3,979.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,838.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,454.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,404.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,119.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,510.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,745.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,072.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,230.06
|
| Rate for Payer: PHCS Commercial |
$4,494.00
|
| Rate for Payer: United Healthcare All Payer |
$4,119.50
|
|
