|
SHEATH MERIT PRELUDE 8FR 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
|
|
|
SHEATH MERIT PRELUDE 8FR 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 NAVIGATOR 13/15 F*36CM
|
Facility
|
OP
|
$3,999.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,199.94 |
| Max. Negotiated Rate |
$3,839.81 |
| Rate for Payer: Aetna Commercial |
$3,079.85
|
| Rate for Payer: Anthem Medicaid |
$1,375.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.84
|
| Rate for Payer: Cash Price |
$1,999.90
|
| Rate for Payer: Cigna Commercial |
$3,319.83
|
| Rate for Payer: First Health Commercial |
$3,799.81
|
| Rate for Payer: Humana Commercial |
$3,399.83
|
| Rate for Payer: Humana KY Medicaid |
$1,375.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,199.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.82
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,199.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,479.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.86
|
| Rate for Payer: PHCS Commercial |
$3,839.81
|
| Rate for Payer: United Healthcare All Payer |
$3,519.82
|
|
|
SHEATH NAVIGATOR 13/15 F*36CM
|
Facility
|
IP
|
$3,999.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,199.94 |
| Max. Negotiated Rate |
$3,839.81 |
| Rate for Payer: Aetna Commercial |
$3,079.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.84
|
| Rate for Payer: Cash Price |
$1,999.90
|
| Rate for Payer: Cigna Commercial |
$3,319.83
|
| Rate for Payer: First Health Commercial |
$3,799.81
|
| Rate for Payer: Humana Commercial |
$3,399.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,199.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.82
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,199.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,479.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.86
|
| Rate for Payer: PHCS Commercial |
$3,839.81
|
| Rate for Payer: United Healthcare All Payer |
$3,519.82
|
|
|
SHEATH PINNACLE 9FR
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
SHEATH PINNACLE 9FR
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
SHEATH PINNACLE DEST 6FR ST
|
Facility
|
IP
|
$1,570.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.15 |
| Max. Negotiated Rate |
$1,507.68 |
| Rate for Payer: Aetna Commercial |
$1,209.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,224.99
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cigna Commercial |
$1,303.52
|
| Rate for Payer: First Health Commercial |
$1,491.97
|
| Rate for Payer: Humana Commercial |
$1,334.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,159.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,382.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,366.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,083.64
|
| Rate for Payer: PHCS Commercial |
$1,507.68
|
| Rate for Payer: United Healthcare All Payer |
$1,382.04
|
|
|
SHEATH PINNACLE DEST 6FR ST
|
Facility
|
OP
|
$1,570.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.15 |
| Max. Negotiated Rate |
$1,507.68 |
| Rate for Payer: Aetna Commercial |
$1,209.29
|
| Rate for Payer: Anthem Medicaid |
$540.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,224.99
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cigna Commercial |
$1,303.52
|
| Rate for Payer: First Health Commercial |
$1,491.97
|
| Rate for Payer: Humana Commercial |
$1,334.92
|
| Rate for Payer: Humana KY Medicaid |
$540.09
|
| Rate for Payer: Kentucky WC Medicaid |
$545.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,159.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$550.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,382.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,366.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,083.64
|
| Rate for Payer: PHCS Commercial |
$1,507.68
|
| Rate for Payer: United Healthcare All Payer |
$1,382.04
|
|
|
SHEATH PINNACLE DEST 7FR ST
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
SHEATH PINNACLE DEST 7FR ST
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
SHEATH SENTRANT HYDRO 12*64
|
Facility
|
IP
|
$3,391.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,017.38 |
| Max. Negotiated Rate |
$3,255.60 |
| Rate for Payer: Aetna Commercial |
$2,611.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,645.18
|
| Rate for Payer: Cash Price |
$1,695.62
|
| Rate for Payer: Cigna Commercial |
$2,814.74
|
| Rate for Payer: First Health Commercial |
$3,221.69
|
| Rate for Payer: Humana Commercial |
$2,882.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,780.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,502.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,984.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,543.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,950.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.96
|
| Rate for Payer: PHCS Commercial |
$3,255.60
|
| Rate for Payer: United Healthcare All Payer |
$2,984.30
|
|
|
SHEATH SENTRANT HYDRO 12*64
|
Facility
|
OP
|
$3,391.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,017.38 |
| Max. Negotiated Rate |
$3,255.60 |
| Rate for Payer: Aetna Commercial |
$2,611.26
|
| Rate for Payer: Anthem Medicaid |
$1,166.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,645.18
|
| Rate for Payer: Cash Price |
$1,695.62
|
| Rate for Payer: Cigna Commercial |
$2,814.74
|
| Rate for Payer: First Health Commercial |
$3,221.69
|
| Rate for Payer: Humana Commercial |
$2,882.56
|
| Rate for Payer: Humana KY Medicaid |
$1,166.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,178.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,780.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,502.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,189.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,984.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,543.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,950.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.96
|
| Rate for Payer: PHCS Commercial |
$3,255.60
|
| Rate for Payer: United Healthcare All Payer |
$2,984.30
|
|
|
SHEATH SENTRANT HYDRO 14*64
|
Facility
|
OP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem Medicaid |
$1,234.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Humana KY Medicaid |
$1,234.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,259.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
SHEATH SENTRANT HYDRO 14*64
|
Facility
|
IP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
SHEATH SENTRANT HYDRO 16*64
|
Facility
|
OP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem Medicaid |
$1,234.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Humana KY Medicaid |
$1,234.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,259.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
SHEATH SENTRANT HYDRO 16*64
|
Facility
|
IP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
SHEATH SENTRANT HYDRO 18*64
|
Facility
|
OP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem Medicaid |
$1,234.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Humana KY Medicaid |
$1,234.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,259.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
SHEATH SENTRANT HYDRO 18*64
|
Facility
|
IP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
SHEATH SENTRANT HYDRO 20*64
|
Facility
|
IP
|
$3,788.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,136.62 |
| Max. Negotiated Rate |
$3,637.20 |
| Rate for Payer: Aetna Commercial |
$2,917.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,955.22
|
| Rate for Payer: Cash Price |
$1,894.38
|
| Rate for Payer: Cigna Commercial |
$3,144.66
|
| Rate for Payer: First Health Commercial |
$3,599.31
|
| Rate for Payer: Humana Commercial |
$3,220.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,796.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,334.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,296.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,614.24
|
| Rate for Payer: PHCS Commercial |
$3,637.20
|
| Rate for Payer: United Healthcare All Payer |
$3,334.10
|
|
|
SHEATH SENTRANT HYDRO 20*64
|
Facility
|
OP
|
$3,788.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,136.62 |
| Max. Negotiated Rate |
$3,637.20 |
| Rate for Payer: Aetna Commercial |
$2,917.34
|
| Rate for Payer: Anthem Medicaid |
$1,302.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,955.22
|
| Rate for Payer: Cash Price |
$1,894.38
|
| Rate for Payer: Cigna Commercial |
$3,144.66
|
| Rate for Payer: First Health Commercial |
$3,599.31
|
| Rate for Payer: Humana Commercial |
$3,220.44
|
| Rate for Payer: Humana KY Medicaid |
$1,302.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,316.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,796.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,329.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,334.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,296.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,614.24
|
| Rate for Payer: PHCS Commercial |
$3,637.20
|
| Rate for Payer: United Healthcare All Payer |
$3,334.10
|
|
|
SHEATH SENTRANT HYDRO 22*64
|
Facility
|
OP
|
$3,788.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,136.62 |
| Max. Negotiated Rate |
$3,637.20 |
| Rate for Payer: Aetna Commercial |
$2,917.34
|
| Rate for Payer: Anthem Medicaid |
$1,302.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,955.22
|
| Rate for Payer: Cash Price |
$1,894.38
|
| Rate for Payer: Cigna Commercial |
$3,144.66
|
| Rate for Payer: First Health Commercial |
$3,599.31
|
| Rate for Payer: Humana Commercial |
$3,220.44
|
| Rate for Payer: Humana KY Medicaid |
$1,302.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,316.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,796.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,329.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,334.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,296.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,614.24
|
| Rate for Payer: PHCS Commercial |
$3,637.20
|
| Rate for Payer: United Healthcare All Payer |
$3,334.10
|
|
|
SHEATH SENTRANT HYDRO 22*64
|
Facility
|
IP
|
$3,788.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,136.62 |
| Max. Negotiated Rate |
$3,637.20 |
| Rate for Payer: Aetna Commercial |
$2,917.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,955.22
|
| Rate for Payer: Cash Price |
$1,894.38
|
| Rate for Payer: Cigna Commercial |
$3,144.66
|
| Rate for Payer: First Health Commercial |
$3,599.31
|
| Rate for Payer: Humana Commercial |
$3,220.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,796.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,334.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,296.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,614.24
|
| Rate for Payer: PHCS Commercial |
$3,637.20
|
| Rate for Payer: United Healthcare All Payer |
$3,334.10
|
|
|
SHEATH SENTRANT HYDRO 24*64
|
Facility
|
IP
|
$3,788.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,136.62 |
| Max. Negotiated Rate |
$3,637.20 |
| Rate for Payer: Aetna Commercial |
$2,917.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,955.22
|
| Rate for Payer: Cash Price |
$1,894.38
|
| Rate for Payer: Cigna Commercial |
$3,144.66
|
| Rate for Payer: First Health Commercial |
$3,599.31
|
| Rate for Payer: Humana Commercial |
$3,220.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,796.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,334.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,296.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,614.24
|
| Rate for Payer: PHCS Commercial |
$3,637.20
|
| Rate for Payer: United Healthcare All Payer |
$3,334.10
|
|
|
SHEATH SENTRANT HYDRO 24*64
|
Facility
|
OP
|
$3,788.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,136.62 |
| Max. Negotiated Rate |
$3,637.20 |
| Rate for Payer: Aetna Commercial |
$2,917.34
|
| Rate for Payer: Anthem Medicaid |
$1,302.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,955.22
|
| Rate for Payer: Cash Price |
$1,894.38
|
| Rate for Payer: Cigna Commercial |
$3,144.66
|
| Rate for Payer: First Health Commercial |
$3,599.31
|
| Rate for Payer: Humana Commercial |
$3,220.44
|
| Rate for Payer: Humana KY Medicaid |
$1,302.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,316.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,796.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,329.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,334.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,296.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,614.24
|
| Rate for Payer: PHCS Commercial |
$3,637.20
|
| Rate for Payer: United Healthcare All Payer |
$3,334.10
|
|
|
SHEATH SENTRANT HYDRO 26*64
|
Facility
|
IP
|
$3,788.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,136.62 |
| Max. Negotiated Rate |
$3,637.20 |
| Rate for Payer: Aetna Commercial |
$2,917.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,955.22
|
| Rate for Payer: Cash Price |
$1,894.38
|
| Rate for Payer: Cigna Commercial |
$3,144.66
|
| Rate for Payer: First Health Commercial |
$3,599.31
|
| Rate for Payer: Humana Commercial |
$3,220.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,796.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,334.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,296.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,614.24
|
| Rate for Payer: PHCS Commercial |
$3,637.20
|
| Rate for Payer: United Healthcare All Payer |
$3,334.10
|
|
