|
SHEATH 24F 25CM
|
Facility
|
IP
|
$3,672.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,101.75 |
| Max. Negotiated Rate |
$3,525.60 |
| Rate for Payer: Cigna Commercial |
$3,048.18
|
| Rate for Payer: First Health Commercial |
$3,488.88
|
| Rate for Payer: Humana Commercial |
$3,121.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,011.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,710.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,231.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,754.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,938.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,195.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,534.03
|
| Rate for Payer: PHCS Commercial |
$3,525.60
|
| Rate for Payer: United Healthcare All Payer |
$3,231.80
|
| Rate for Payer: Aetna Commercial |
$2,827.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,864.55
|
| Rate for Payer: Cash Price |
$1,836.25
|
|
|
SHEATH 5FR
|
Facility
|
IP
|
$488.73
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.62 |
| Max. Negotiated Rate |
$469.18 |
| Rate for Payer: Aetna Commercial |
$376.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$381.21
|
| Rate for Payer: Cash Price |
$244.36
|
| Rate for Payer: Cigna Commercial |
$405.65
|
| Rate for Payer: First Health Commercial |
$464.29
|
| Rate for Payer: Humana Commercial |
$415.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.08
|
| Rate for Payer: Ohio Health Group HMO |
$366.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.22
|
| Rate for Payer: PHCS Commercial |
$469.18
|
| Rate for Payer: United Healthcare All Payer |
$430.08
|
|
|
SHEATH 5FR
|
Facility
|
OP
|
$488.73
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.62 |
| Max. Negotiated Rate |
$469.18 |
| Rate for Payer: Aetna Commercial |
$376.32
|
| Rate for Payer: Anthem Medicaid |
$168.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$381.21
|
| Rate for Payer: Cash Price |
$244.36
|
| Rate for Payer: Cigna Commercial |
$405.65
|
| Rate for Payer: First Health Commercial |
$464.29
|
| Rate for Payer: Humana Commercial |
$415.42
|
| Rate for Payer: Humana KY Medicaid |
$168.07
|
| Rate for Payer: Kentucky WC Medicaid |
$169.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$171.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.08
|
| Rate for Payer: Ohio Health Group HMO |
$366.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.22
|
| Rate for Payer: PHCS Commercial |
$469.18
|
| Rate for Payer: United Healthcare All Payer |
$430.08
|
|
|
SHEATH 8 FR 353893
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem Medicaid |
$404.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Humana KY Medicaid |
$404.08
|
| Rate for Payer: Kentucky WC Medicaid |
$408.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$412.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
SHEATH 8 FR 353893
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
SHEATH ADAPTER W/SHIELD
|
Facility
|
IP
|
$528.38
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.51 |
| Max. Negotiated Rate |
$507.24 |
| Rate for Payer: Aetna Commercial |
$406.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$412.14
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cigna Commercial |
$438.56
|
| Rate for Payer: First Health Commercial |
$501.96
|
| Rate for Payer: Humana Commercial |
$449.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$433.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.97
|
| Rate for Payer: Ohio Health Group HMO |
$396.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.58
|
| Rate for Payer: PHCS Commercial |
$507.24
|
| Rate for Payer: United Healthcare All Payer |
$464.97
|
|
|
SHEATH ADAPTER W/SHIELD
|
Facility
|
OP
|
$528.38
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.51 |
| Max. Negotiated Rate |
$507.24 |
| Rate for Payer: Aetna Commercial |
$406.85
|
| Rate for Payer: Anthem Medicaid |
$181.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$412.14
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cigna Commercial |
$438.56
|
| Rate for Payer: First Health Commercial |
$501.96
|
| Rate for Payer: Humana Commercial |
$449.12
|
| Rate for Payer: Humana KY Medicaid |
$181.71
|
| Rate for Payer: Kentucky WC Medicaid |
$183.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$433.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.97
|
| Rate for Payer: Ohio Health Group HMO |
$396.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.58
|
| Rate for Payer: PHCS Commercial |
$507.24
|
| Rate for Payer: United Healthcare All Payer |
$464.97
|
|
|
SHEATH AMPLATZ RENAL 24FR
|
Facility
|
IP
|
$793.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.05 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$618.93
|
| Rate for Payer: Cash Price |
$396.75
|
| Rate for Payer: Cigna Commercial |
$658.61
|
| Rate for Payer: First Health Commercial |
$753.83
|
| Rate for Payer: Humana Commercial |
$674.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.28
|
| Rate for Payer: Ohio Health Group HMO |
$595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.51
|
| Rate for Payer: PHCS Commercial |
$761.76
|
| Rate for Payer: United Healthcare All Payer |
$698.28
|
|
|
SHEATH AMPLATZ RENAL 24FR
|
Facility
|
OP
|
$793.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.05 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$611.00
|
| Rate for Payer: Anthem Medicaid |
$272.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$618.93
|
| Rate for Payer: Cash Price |
$396.75
|
| Rate for Payer: Cigna Commercial |
$658.61
|
| Rate for Payer: First Health Commercial |
$753.83
|
| Rate for Payer: Humana Commercial |
$674.48
|
| Rate for Payer: Humana KY Medicaid |
$272.88
|
| Rate for Payer: Kentucky WC Medicaid |
$275.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.28
|
| Rate for Payer: Ohio Health Group HMO |
$595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.51
|
| Rate for Payer: PHCS Commercial |
$761.76
|
| Rate for Payer: United Healthcare All Payer |
$698.28
|
|
|
SHEATH AMPLATZ RENAL 28FR
|
Facility
|
IP
|
$793.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.05 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$618.93
|
| Rate for Payer: Cash Price |
$396.75
|
| Rate for Payer: Cigna Commercial |
$658.61
|
| Rate for Payer: First Health Commercial |
$753.83
|
| Rate for Payer: Humana Commercial |
$674.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.28
|
| Rate for Payer: Ohio Health Group HMO |
$595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.51
|
| Rate for Payer: PHCS Commercial |
$761.76
|
| Rate for Payer: United Healthcare All Payer |
$698.28
|
|
|
SHEATH AMPLATZ RENAL 28FR
|
Facility
|
OP
|
$793.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.05 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$611.00
|
| Rate for Payer: Anthem Medicaid |
$272.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$618.93
|
| Rate for Payer: Cash Price |
$396.75
|
| Rate for Payer: Cigna Commercial |
$658.61
|
| Rate for Payer: First Health Commercial |
$753.83
|
| Rate for Payer: Humana Commercial |
$674.48
|
| Rate for Payer: Humana KY Medicaid |
$272.88
|
| Rate for Payer: Kentucky WC Medicaid |
$275.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.28
|
| Rate for Payer: Ohio Health Group HMO |
$595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.51
|
| Rate for Payer: PHCS Commercial |
$761.76
|
| Rate for Payer: United Healthcare All Payer |
$698.28
|
|
|
SHEATH AMPLATZ RENAL 30FR
|
Facility
|
OP
|
$793.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.05 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$611.00
|
| Rate for Payer: Anthem Medicaid |
$272.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$618.93
|
| Rate for Payer: Cash Price |
$396.75
|
| Rate for Payer: Cigna Commercial |
$658.61
|
| Rate for Payer: First Health Commercial |
$753.83
|
| Rate for Payer: Humana Commercial |
$674.48
|
| Rate for Payer: Humana KY Medicaid |
$272.88
|
| Rate for Payer: Kentucky WC Medicaid |
$275.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.28
|
| Rate for Payer: Ohio Health Group HMO |
$595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.51
|
| Rate for Payer: PHCS Commercial |
$761.76
|
| Rate for Payer: United Healthcare All Payer |
$698.28
|
|
|
SHEATH AMPLATZ RENAL 30FR
|
Facility
|
IP
|
$793.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.05 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$618.93
|
| Rate for Payer: Cash Price |
$396.75
|
| Rate for Payer: Cigna Commercial |
$658.61
|
| Rate for Payer: First Health Commercial |
$753.83
|
| Rate for Payer: Humana Commercial |
$674.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.28
|
| Rate for Payer: Ohio Health Group HMO |
$595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.51
|
| Rate for Payer: PHCS Commercial |
$761.76
|
| Rate for Payer: United Healthcare All Payer |
$698.28
|
|
|
SHEATH AV ACCESS TUN CVD
|
Facility
|
IP
|
$1,194.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$1,146.24 |
| Rate for Payer: Aetna Commercial |
$919.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$931.32
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$991.02
|
| Rate for Payer: First Health Commercial |
$1,134.30
|
| Rate for Payer: Humana Commercial |
$1,014.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$979.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$881.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,050.72
|
| Rate for Payer: Ohio Health Group HMO |
$895.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,038.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$823.86
|
| Rate for Payer: PHCS Commercial |
$1,146.24
|
| Rate for Payer: United Healthcare All Payer |
$1,050.72
|
|
|
SHEATH AV ACCESS TUN CVD
|
Facility
|
OP
|
$1,194.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$1,146.24 |
| Rate for Payer: Aetna Commercial |
$919.38
|
| Rate for Payer: Anthem Medicaid |
$410.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$931.32
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$991.02
|
| Rate for Payer: First Health Commercial |
$1,134.30
|
| Rate for Payer: Humana Commercial |
$1,014.90
|
| Rate for Payer: Humana KY Medicaid |
$410.62
|
| Rate for Payer: Kentucky WC Medicaid |
$414.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$979.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$881.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$418.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,050.72
|
| Rate for Payer: Ohio Health Group HMO |
$895.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,038.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$823.86
|
| Rate for Payer: PHCS Commercial |
$1,146.24
|
| Rate for Payer: United Healthcare All Payer |
$1,050.72
|
|
|
SHEATH BIO-INTRAFIX 9*30
|
Facility
|
IP
|
$1,949.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$584.94 |
| Max. Negotiated Rate |
$1,871.81 |
| Rate for Payer: Aetna Commercial |
$1,501.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.84
|
| Rate for Payer: Cash Price |
$974.90
|
| Rate for Payer: Cigna Commercial |
$1,618.33
|
| Rate for Payer: First Health Commercial |
$1,852.31
|
| Rate for Payer: Humana Commercial |
$1,657.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,559.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.36
|
| Rate for Payer: PHCS Commercial |
$1,871.81
|
| Rate for Payer: United Healthcare All Payer |
$1,715.82
|
|
|
SHEATH BIO-INTRAFIX 9*30
|
Facility
|
OP
|
$1,949.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$584.94 |
| Max. Negotiated Rate |
$1,871.81 |
| Rate for Payer: Aetna Commercial |
$1,501.35
|
| Rate for Payer: Anthem Medicaid |
$670.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.84
|
| Rate for Payer: Cash Price |
$974.90
|
| Rate for Payer: Cigna Commercial |
$1,618.33
|
| Rate for Payer: First Health Commercial |
$1,852.31
|
| Rate for Payer: Humana Commercial |
$1,657.33
|
| Rate for Payer: Humana KY Medicaid |
$670.54
|
| Rate for Payer: Kentucky WC Medicaid |
$677.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,559.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.36
|
| Rate for Payer: PHCS Commercial |
$1,871.81
|
| Rate for Payer: United Healthcare All Payer |
$1,715.82
|
|
|
SHEATH CHECK-FLO 14*30
|
Facility
|
IP
|
$1,801.90
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.57 |
| Max. Negotiated Rate |
$1,729.82 |
| Rate for Payer: Aetna Commercial |
$1,387.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.48
|
| Rate for Payer: Cash Price |
$900.95
|
| Rate for Payer: Cigna Commercial |
$1,495.58
|
| Rate for Payer: First Health Commercial |
$1,711.81
|
| Rate for Payer: Humana Commercial |
$1,531.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,243.31
|
| Rate for Payer: PHCS Commercial |
$1,729.82
|
| Rate for Payer: United Healthcare All Payer |
$1,585.67
|
|
|
SHEATH CHECK-FLO 14*30
|
Facility
|
OP
|
$1,801.90
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.57 |
| Max. Negotiated Rate |
$1,729.82 |
| Rate for Payer: Aetna Commercial |
$1,387.46
|
| Rate for Payer: Anthem Medicaid |
$619.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.48
|
| Rate for Payer: Cash Price |
$900.95
|
| Rate for Payer: Cigna Commercial |
$1,495.58
|
| Rate for Payer: First Health Commercial |
$1,711.81
|
| Rate for Payer: Humana Commercial |
$1,531.62
|
| Rate for Payer: Humana KY Medicaid |
$619.67
|
| Rate for Payer: Kentucky WC Medicaid |
$625.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,243.31
|
| Rate for Payer: PHCS Commercial |
$1,729.82
|
| Rate for Payer: United Healthcare All Payer |
$1,585.67
|
|
|
SHEATH CLASSIC 7FR CLS-2507
|
Facility
|
OP
|
$1,572.40
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.72 |
| Max. Negotiated Rate |
$1,509.50 |
| Rate for Payer: Aetna Commercial |
$1,210.75
|
| Rate for Payer: Anthem Medicaid |
$540.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.47
|
| Rate for Payer: Cash Price |
$786.20
|
| Rate for Payer: Cigna Commercial |
$1,305.09
|
| Rate for Payer: First Health Commercial |
$1,493.78
|
| Rate for Payer: Humana Commercial |
$1,336.54
|
| Rate for Payer: Humana KY Medicaid |
$540.75
|
| Rate for Payer: Kentucky WC Medicaid |
$546.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,257.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,367.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,084.96
|
| Rate for Payer: PHCS Commercial |
$1,509.50
|
| Rate for Payer: United Healthcare All Payer |
$1,383.71
|
|
|
SHEATH CLASSIC 7FR CLS-2507
|
Facility
|
IP
|
$1,572.40
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.72 |
| Max. Negotiated Rate |
$1,509.50 |
| Rate for Payer: Aetna Commercial |
$1,210.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.47
|
| Rate for Payer: Cash Price |
$786.20
|
| Rate for Payer: Cigna Commercial |
$1,305.09
|
| Rate for Payer: First Health Commercial |
$1,493.78
|
| Rate for Payer: Humana Commercial |
$1,336.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,257.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,367.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,084.96
|
| Rate for Payer: PHCS Commercial |
$1,509.50
|
| Rate for Payer: United Healthcare All Payer |
$1,383.71
|
|
|
SHEATH CLEAR
|
Facility
|
IP
|
$847.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.25 |
| Max. Negotiated Rate |
$813.60 |
| Rate for Payer: Aetna Commercial |
$652.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$661.05
|
| Rate for Payer: Cash Price |
$423.75
|
| Rate for Payer: Cigna Commercial |
$703.42
|
| Rate for Payer: First Health Commercial |
$805.12
|
| Rate for Payer: Humana Commercial |
$720.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$694.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$625.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$745.80
|
| Rate for Payer: Ohio Health Group HMO |
$635.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$737.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.77
|
| Rate for Payer: PHCS Commercial |
$813.60
|
| Rate for Payer: United Healthcare All Payer |
$745.80
|
|
|
SHEATH CLEAR
|
Facility
|
OP
|
$847.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.25 |
| Max. Negotiated Rate |
$813.60 |
| Rate for Payer: Aetna Commercial |
$652.58
|
| Rate for Payer: Anthem Medicaid |
$291.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$661.05
|
| Rate for Payer: Cash Price |
$423.75
|
| Rate for Payer: Cigna Commercial |
$703.42
|
| Rate for Payer: First Health Commercial |
$805.12
|
| Rate for Payer: Humana Commercial |
$720.38
|
| Rate for Payer: Humana KY Medicaid |
$291.46
|
| Rate for Payer: Kentucky WC Medicaid |
$294.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$694.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$625.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$297.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$745.80
|
| Rate for Payer: Ohio Health Group HMO |
$635.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$737.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.77
|
| Rate for Payer: PHCS Commercial |
$813.60
|
| Rate for Payer: United Healthcare All Payer |
$745.80
|
|
|
SHEATH CPS DIRECT PL 410171
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
SHEATH CPS DIRECT PL 410171
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
