|
SHEATH CPS DIRECT PL 410187
|
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 SL 410116
|
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 SL 410116
|
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
|
|
|
SHEATH CPS DIRECT SL 410125
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SHEATH CPS DIRECT SL 410125
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SHEATH DESTINO STEERABLE 55CM
|
Facility
|
IP
|
$6,828.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,048.66 |
| Max. Negotiated Rate |
$6,555.70 |
| Rate for Payer: Aetna Commercial |
$5,258.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,326.50
|
| Rate for Payer: Cash Price |
$3,414.43
|
| Rate for Payer: Cigna Commercial |
$5,667.95
|
| Rate for Payer: First Health Commercial |
$6,487.41
|
| Rate for Payer: Humana Commercial |
$5,804.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,599.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,009.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,121.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,463.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,941.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,711.91
|
| Rate for Payer: PHCS Commercial |
$6,555.70
|
| Rate for Payer: United Healthcare All Payer |
$6,009.39
|
|
|
SHEATH DESTINO STEERABLE 55CM
|
Facility
|
OP
|
$6,828.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,048.66 |
| Max. Negotiated Rate |
$6,555.70 |
| Rate for Payer: Aetna Commercial |
$5,258.21
|
| Rate for Payer: Anthem Medicaid |
$2,348.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,326.50
|
| Rate for Payer: Cash Price |
$3,414.43
|
| Rate for Payer: Cigna Commercial |
$5,667.95
|
| Rate for Payer: First Health Commercial |
$6,487.41
|
| Rate for Payer: Humana Commercial |
$5,804.52
|
| Rate for Payer: Humana KY Medicaid |
$2,348.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,372.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,599.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,395.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,009.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,121.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,463.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,941.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,711.91
|
| Rate for Payer: PHCS Commercial |
$6,555.70
|
| Rate for Payer: United Healthcare All Payer |
$6,009.39
|
|
|
SHEATH DRYSEAL FLX 33C 16FR
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
SHEATH DRYSEAL FLX 33C 16FR
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
SHEATH DRYSEAL FLX 33C 18FR
|
Facility
|
OP
|
$6,810.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,043.18 |
| Max. Negotiated Rate |
$6,538.18 |
| Rate for Payer: Aetna Commercial |
$5,244.16
|
| Rate for Payer: Anthem Medicaid |
$2,342.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,312.27
|
| Rate for Payer: Cash Price |
$3,405.30
|
| Rate for Payer: Cigna Commercial |
$5,652.80
|
| Rate for Payer: First Health Commercial |
$6,470.07
|
| Rate for Payer: Humana Commercial |
$5,789.01
|
| Rate for Payer: Humana KY Medicaid |
$2,342.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,366.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,584.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,026.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,389.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,993.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,107.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,448.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,925.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,699.31
|
| Rate for Payer: PHCS Commercial |
$6,538.18
|
| Rate for Payer: United Healthcare All Payer |
$5,993.33
|
|
|
SHEATH DRYSEAL FLX 33C 18FR
|
Facility
|
IP
|
$6,810.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,043.18 |
| Max. Negotiated Rate |
$6,538.18 |
| Rate for Payer: Aetna Commercial |
$5,244.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,312.27
|
| Rate for Payer: Cash Price |
$3,405.30
|
| Rate for Payer: Cigna Commercial |
$5,652.80
|
| Rate for Payer: First Health Commercial |
$6,470.07
|
| Rate for Payer: Humana Commercial |
$5,789.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,584.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,026.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,993.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,107.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,448.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,925.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,699.31
|
| Rate for Payer: PHCS Commercial |
$6,538.18
|
| Rate for Payer: United Healthcare All Payer |
$5,993.33
|
|
|
SHEATH DRYSEAL FLX 45C 12FR
|
Facility
|
IP
|
$4,838.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,451.62 |
| Max. Negotiated Rate |
$4,645.20 |
| Rate for Payer: Aetna Commercial |
$3,725.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,774.22
|
| Rate for Payer: Cash Price |
$2,419.38
|
| Rate for Payer: Cigna Commercial |
$4,016.16
|
| Rate for Payer: First Health Commercial |
$4,596.81
|
| Rate for Payer: Humana Commercial |
$4,112.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,967.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,258.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,629.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,871.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,209.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,338.74
|
| Rate for Payer: PHCS Commercial |
$4,645.20
|
| Rate for Payer: United Healthcare All Payer |
$4,258.10
|
|
|
SHEATH DRYSEAL FLX 45C 12FR
|
Facility
|
OP
|
$4,838.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,451.62 |
| Max. Negotiated Rate |
$4,645.20 |
| Rate for Payer: Aetna Commercial |
$3,725.84
|
| Rate for Payer: Anthem Medicaid |
$1,664.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,774.22
|
| Rate for Payer: Cash Price |
$2,419.38
|
| Rate for Payer: Cigna Commercial |
$4,016.16
|
| Rate for Payer: First Health Commercial |
$4,596.81
|
| Rate for Payer: Humana Commercial |
$4,112.94
|
| Rate for Payer: Humana KY Medicaid |
$1,664.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,680.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,967.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,697.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,258.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,629.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,871.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,209.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,338.74
|
| Rate for Payer: PHCS Commercial |
$4,645.20
|
| Rate for Payer: United Healthcare All Payer |
$4,258.10
|
|
|
SHEATH INNER
|
Facility
|
IP
|
$4,523.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,357.12 |
| Max. Negotiated Rate |
$4,342.80 |
| Rate for Payer: Aetna Commercial |
$3,483.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,528.53
|
| Rate for Payer: Cash Price |
$2,261.88
|
| Rate for Payer: Cigna Commercial |
$3,754.71
|
| Rate for Payer: First Health Commercial |
$4,297.56
|
| Rate for Payer: Humana Commercial |
$3,845.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,709.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,338.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,357.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,980.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,392.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,619.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,121.39
|
| Rate for Payer: PHCS Commercial |
$4,342.80
|
| Rate for Payer: United Healthcare All Payer |
$3,980.90
|
|
|
SHEATH INNER
|
Facility
|
OP
|
$4,523.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,357.12 |
| Max. Negotiated Rate |
$4,342.80 |
| Rate for Payer: Aetna Commercial |
$3,483.29
|
| Rate for Payer: Anthem Medicaid |
$1,555.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,528.53
|
| Rate for Payer: Cash Price |
$2,261.88
|
| Rate for Payer: Cigna Commercial |
$3,754.71
|
| Rate for Payer: First Health Commercial |
$4,297.56
|
| Rate for Payer: Humana Commercial |
$3,845.19
|
| Rate for Payer: Humana KY Medicaid |
$1,555.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,571.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,709.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,338.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,357.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,586.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,980.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,392.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,619.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,121.39
|
| Rate for Payer: PHCS Commercial |
$4,342.80
|
| Rate for Payer: United Healthcare All Payer |
$3,980.90
|
|
|
SHEATH INTERVENTIONAL #8
|
Facility
|
OP
|
$762.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.75 |
| Max. Negotiated Rate |
$732.00 |
| Rate for Payer: Aetna Commercial |
$587.12
|
| Rate for Payer: Anthem Medicaid |
$262.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.75
|
| Rate for Payer: Cash Price |
$381.25
|
| Rate for Payer: Cigna Commercial |
$632.88
|
| Rate for Payer: First Health Commercial |
$724.38
|
| Rate for Payer: Humana Commercial |
$648.12
|
| Rate for Payer: Humana KY Medicaid |
$262.22
|
| Rate for Payer: Kentucky WC Medicaid |
$264.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.00
|
| Rate for Payer: Ohio Health Group HMO |
$571.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.12
|
| Rate for Payer: PHCS Commercial |
$732.00
|
| Rate for Payer: United Healthcare All Payer |
$671.00
|
|
|
SHEATH INTERVENTIONAL #8
|
Facility
|
IP
|
$762.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.75 |
| Max. Negotiated Rate |
$732.00 |
| Rate for Payer: Aetna Commercial |
$587.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.75
|
| Rate for Payer: Cash Price |
$381.25
|
| Rate for Payer: Cigna Commercial |
$632.88
|
| Rate for Payer: First Health Commercial |
$724.38
|
| Rate for Payer: Humana Commercial |
$648.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.00
|
| Rate for Payer: Ohio Health Group HMO |
$571.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.12
|
| Rate for Payer: PHCS Commercial |
$732.00
|
| Rate for Payer: United Healthcare All Payer |
$671.00
|
|
|
SHEATH INTRO 6.5FR
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
SHEATH INTRO 6.5FR
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem Medicaid |
$510.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Humana KY Medicaid |
$510.69
|
| Rate for Payer: Kentucky WC Medicaid |
$515.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
SHEATH INTRODUCER CLASSIC 6FR
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
SHEATH INTRODUCER CLASSIC 6FR
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
SHEATH INTRODUCER DEVICE 17FR
|
Facility
|
IP
|
$3,871.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,161.38 |
| Max. Negotiated Rate |
$3,716.40 |
| Rate for Payer: Aetna Commercial |
$2,980.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,019.57
|
| Rate for Payer: Cash Price |
$1,935.62
|
| Rate for Payer: Cigna Commercial |
$3,213.14
|
| Rate for Payer: First Health Commercial |
$3,677.69
|
| Rate for Payer: Humana Commercial |
$3,290.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,174.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,856.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,406.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,903.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,367.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.16
|
| Rate for Payer: PHCS Commercial |
$3,716.40
|
| Rate for Payer: United Healthcare All Payer |
$3,406.70
|
|
|
SHEATH INTRODUCER DEVICE 17FR
|
Facility
|
OP
|
$3,871.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,161.38 |
| Max. Negotiated Rate |
$3,716.40 |
| Rate for Payer: Aetna Commercial |
$2,980.86
|
| Rate for Payer: Anthem Medicaid |
$1,331.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,019.57
|
| Rate for Payer: Cash Price |
$1,935.62
|
| Rate for Payer: Cigna Commercial |
$3,213.14
|
| Rate for Payer: First Health Commercial |
$3,677.69
|
| Rate for Payer: Humana Commercial |
$3,290.56
|
| Rate for Payer: Humana KY Medicaid |
$1,331.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,344.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,174.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,856.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,358.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,406.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,903.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,367.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.16
|
| Rate for Payer: PHCS Commercial |
$3,716.40
|
| Rate for Payer: United Healthcare All Payer |
$3,406.70
|
|
|
SHEATH MERIT PRELUDE 6FR 13CM
|
Facility
|
IP
|
$1,492.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.78 |
| Max. Negotiated Rate |
$1,432.90 |
| Rate for Payer: Aetna Commercial |
$1,149.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,164.23
|
| Rate for Payer: Cash Price |
$746.30
|
| Rate for Payer: Cigna Commercial |
$1,238.86
|
| Rate for Payer: First Health Commercial |
$1,417.97
|
| Rate for Payer: Humana Commercial |
$1,268.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,223.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,101.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,313.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,119.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,194.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,298.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.89
|
| Rate for Payer: PHCS Commercial |
$1,432.90
|
| Rate for Payer: United Healthcare All Payer |
$1,313.49
|
|
|
SHEATH MERIT PRELUDE 6FR 13CM
|
Facility
|
OP
|
$1,492.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.78 |
| Max. Negotiated Rate |
$1,432.90 |
| Rate for Payer: Aetna Commercial |
$1,149.30
|
| Rate for Payer: Anthem Medicaid |
$513.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,164.23
|
| Rate for Payer: Cash Price |
$746.30
|
| Rate for Payer: Cigna Commercial |
$1,238.86
|
| Rate for Payer: First Health Commercial |
$1,417.97
|
| Rate for Payer: Humana Commercial |
$1,268.71
|
| Rate for Payer: Humana KY Medicaid |
$513.31
|
| Rate for Payer: Kentucky WC Medicaid |
$518.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,223.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,101.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$523.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,313.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,119.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,194.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,298.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.89
|
| Rate for Payer: PHCS Commercial |
$1,432.90
|
| Rate for Payer: United Healthcare All Payer |
$1,313.49
|
|
