|
SHEATH SENTRANT HYDRO 26*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 SUPER CBDE
|
Facility
|
IP
|
$3,462.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,038.75 |
| Max. Negotiated Rate |
$3,324.00 |
| Rate for Payer: Aetna Commercial |
$2,666.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.75
|
| Rate for Payer: Cash Price |
$1,731.25
|
| Rate for Payer: Cigna Commercial |
$2,873.88
|
| Rate for Payer: First Health Commercial |
$3,289.38
|
| Rate for Payer: Humana Commercial |
$2,943.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,770.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,012.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,389.12
|
| Rate for Payer: PHCS Commercial |
$3,324.00
|
| Rate for Payer: United Healthcare All Payer |
$3,047.00
|
|
|
SHEATH SUPER CBDE
|
Facility
|
OP
|
$3,462.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,038.75 |
| Max. Negotiated Rate |
$3,324.00 |
| Rate for Payer: Aetna Commercial |
$2,666.12
|
| Rate for Payer: Anthem Medicaid |
$1,190.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.75
|
| Rate for Payer: Cash Price |
$1,731.25
|
| Rate for Payer: Cigna Commercial |
$2,873.88
|
| Rate for Payer: First Health Commercial |
$3,289.38
|
| Rate for Payer: Humana Commercial |
$2,943.12
|
| Rate for Payer: Humana KY Medicaid |
$1,190.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,202.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,770.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,012.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,389.12
|
| Rate for Payer: PHCS Commercial |
$3,324.00
|
| Rate for Payer: United Healthcare All Payer |
$3,047.00
|
|
|
SHEATH TUN DISP SCANLAN SM
|
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 TUN DISP SCANLAN SM
|
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 W/GW 6FR*10CM*.038
|
Facility
|
IP
|
$167.06
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna Commercial |
$128.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.31
|
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Cigna Commercial |
$138.66
|
| Rate for Payer: First Health Commercial |
$158.71
|
| Rate for Payer: Humana Commercial |
$142.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.01
|
| Rate for Payer: Ohio Health Group HMO |
$125.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.27
|
| Rate for Payer: PHCS Commercial |
$160.38
|
| Rate for Payer: United Healthcare All Payer |
$147.01
|
|
|
SHEATH W/GW 6FR*10CM*.038
|
Facility
|
OP
|
$167.06
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna Commercial |
$128.64
|
| Rate for Payer: Anthem Medicaid |
$57.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.31
|
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Cigna Commercial |
$138.66
|
| Rate for Payer: First Health Commercial |
$158.71
|
| Rate for Payer: Humana Commercial |
$142.00
|
| Rate for Payer: Humana KY Medicaid |
$57.45
|
| Rate for Payer: Kentucky WC Medicaid |
$58.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.01
|
| Rate for Payer: Ohio Health Group HMO |
$125.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.27
|
| Rate for Payer: PHCS Commercial |
$160.38
|
| Rate for Payer: United Healthcare All Payer |
$147.01
|
|
|
SHEATH W/ GW 7FR*10CM*.038
|
Facility
|
OP
|
$3,123.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$936.94 |
| Max. Negotiated Rate |
$2,998.20 |
| Rate for Payer: Aetna Commercial |
$2,404.80
|
| Rate for Payer: Anthem Medicaid |
$1,074.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,436.03
|
| Rate for Payer: Cash Price |
$1,561.56
|
| Rate for Payer: Cigna Commercial |
$2,592.19
|
| Rate for Payer: First Health Commercial |
$2,966.96
|
| Rate for Payer: Humana Commercial |
$2,654.65
|
| Rate for Payer: Humana KY Medicaid |
$1,074.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,084.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,560.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,304.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,095.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,748.35
|
| Rate for Payer: Ohio Health Group HMO |
$2,342.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,498.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,717.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,154.95
|
| Rate for Payer: PHCS Commercial |
$2,998.20
|
| Rate for Payer: United Healthcare All Payer |
$2,748.35
|
|
|
SHEATH W/ GW 7FR*10CM*.038
|
Facility
|
IP
|
$3,123.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$936.94 |
| Max. Negotiated Rate |
$2,998.20 |
| Rate for Payer: Aetna Commercial |
$2,404.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,436.03
|
| Rate for Payer: Cash Price |
$1,561.56
|
| Rate for Payer: Cigna Commercial |
$2,592.19
|
| Rate for Payer: First Health Commercial |
$2,966.96
|
| Rate for Payer: Humana Commercial |
$2,654.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,560.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,304.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,748.35
|
| Rate for Payer: Ohio Health Group HMO |
$2,342.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,498.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,717.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,154.95
|
| Rate for Payer: PHCS Commercial |
$2,998.20
|
| Rate for Payer: United Healthcare All Payer |
$2,748.35
|
|
|
SHEATH W/O GW 6FR*10CM*.038
|
Facility
|
IP
|
$567.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.15 |
| Max. Negotiated Rate |
$544.47 |
| Rate for Payer: Aetna Commercial |
$436.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$442.38
|
| Rate for Payer: Cash Price |
$283.58
|
| Rate for Payer: Cigna Commercial |
$470.74
|
| Rate for Payer: First Health Commercial |
$538.80
|
| Rate for Payer: Humana Commercial |
$482.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$465.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$418.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$499.10
|
| Rate for Payer: Ohio Health Group HMO |
$425.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.34
|
| Rate for Payer: PHCS Commercial |
$544.47
|
| Rate for Payer: United Healthcare All Payer |
$499.10
|
|
|
SHEATH W/O GW 6FR*10CM*.038
|
Facility
|
OP
|
$567.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.15 |
| Max. Negotiated Rate |
$544.47 |
| Rate for Payer: Aetna Commercial |
$436.71
|
| Rate for Payer: Anthem Medicaid |
$195.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$442.38
|
| Rate for Payer: Cash Price |
$283.58
|
| Rate for Payer: Cigna Commercial |
$470.74
|
| Rate for Payer: First Health Commercial |
$538.80
|
| Rate for Payer: Humana Commercial |
$482.09
|
| Rate for Payer: Humana KY Medicaid |
$195.05
|
| Rate for Payer: Kentucky WC Medicaid |
$197.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$465.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$418.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$499.10
|
| Rate for Payer: Ohio Health Group HMO |
$425.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.34
|
| Rate for Payer: PHCS Commercial |
$544.47
|
| Rate for Payer: United Healthcare All Payer |
$499.10
|
|
|
SHEATH W/O GW 6FR*25CM*.038
|
Facility
|
OP
|
$789.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$758.16 |
| Rate for Payer: Aetna Commercial |
$608.11
|
| Rate for Payer: Anthem Medicaid |
$271.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.00
|
| Rate for Payer: Cash Price |
$394.88
|
| Rate for Payer: Cigna Commercial |
$655.49
|
| Rate for Payer: First Health Commercial |
$750.26
|
| Rate for Payer: Humana Commercial |
$671.29
|
| Rate for Payer: Humana KY Medicaid |
$271.60
|
| Rate for Payer: Kentucky WC Medicaid |
$274.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$647.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$582.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$277.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$694.98
|
| Rate for Payer: Ohio Health Group HMO |
$592.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$687.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.93
|
| Rate for Payer: PHCS Commercial |
$758.16
|
| Rate for Payer: United Healthcare All Payer |
$694.98
|
|
|
SHEATH W/O GW 6FR*25CM*.038
|
Facility
|
IP
|
$789.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$758.16 |
| Rate for Payer: Aetna Commercial |
$608.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.00
|
| Rate for Payer: Cash Price |
$394.88
|
| Rate for Payer: Cigna Commercial |
$655.49
|
| Rate for Payer: First Health Commercial |
$750.26
|
| Rate for Payer: Humana Commercial |
$671.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$647.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$582.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$694.98
|
| Rate for Payer: Ohio Health Group HMO |
$592.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$687.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.93
|
| Rate for Payer: PHCS Commercial |
$758.16
|
| Rate for Payer: United Healthcare All Payer |
$694.98
|
|
|
SHEATH W/O GW 7FR*25CM*.038
|
Facility
|
IP
|
$41.95
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.72
|
| Rate for Payer: Cash Price |
$20.98
|
| Rate for Payer: Cigna Commercial |
$34.82
|
| Rate for Payer: First Health Commercial |
$39.85
|
| Rate for Payer: Humana Commercial |
$35.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.92
|
| Rate for Payer: Ohio Health Group HMO |
$31.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.95
|
| Rate for Payer: PHCS Commercial |
$40.27
|
| Rate for Payer: United Healthcare All Payer |
$36.92
|
|
|
SHEATH W/O GW 7FR*25CM*.038
|
Facility
|
OP
|
$41.95
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Anthem Medicaid |
$14.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.72
|
| Rate for Payer: Cash Price |
$20.98
|
| Rate for Payer: Cigna Commercial |
$34.82
|
| Rate for Payer: First Health Commercial |
$39.85
|
| Rate for Payer: Humana Commercial |
$35.66
|
| Rate for Payer: Humana KY Medicaid |
$14.43
|
| Rate for Payer: Kentucky WC Medicaid |
$14.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.92
|
| Rate for Payer: Ohio Health Group HMO |
$31.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.95
|
| Rate for Payer: PHCS Commercial |
$40.27
|
| Rate for Payer: United Healthcare All Payer |
$36.92
|
|
|
SHEATH W/O GW 8FR*10CM*.038
|
Facility
|
OP
|
$521.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.48 |
| Max. Negotiated Rate |
$500.74 |
| Rate for Payer: Aetna Commercial |
$401.63
|
| Rate for Payer: Anthem Medicaid |
$179.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.85
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cigna Commercial |
$432.93
|
| Rate for Payer: First Health Commercial |
$495.52
|
| Rate for Payer: Humana Commercial |
$443.36
|
| Rate for Payer: Humana KY Medicaid |
$179.38
|
| Rate for Payer: Kentucky WC Medicaid |
$181.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$459.01
|
| Rate for Payer: Ohio Health Group HMO |
$391.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.90
|
| Rate for Payer: PHCS Commercial |
$500.74
|
| Rate for Payer: United Healthcare All Payer |
$459.01
|
|
|
SHEATH W/O GW 8FR*10CM*.038
|
Facility
|
IP
|
$521.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.48 |
| Max. Negotiated Rate |
$500.74 |
| Rate for Payer: Aetna Commercial |
$401.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.85
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cigna Commercial |
$432.93
|
| Rate for Payer: First Health Commercial |
$495.52
|
| Rate for Payer: Humana Commercial |
$443.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$459.01
|
| Rate for Payer: Ohio Health Group HMO |
$391.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.90
|
| Rate for Payer: PHCS Commercial |
$500.74
|
| Rate for Payer: United Healthcare All Payer |
$459.01
|
|
|
SHEEP SORREL IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
SHEEP SORREL IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
SHEETING SILICONE 2*3*.020
|
Facility
|
IP
|
$772.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$741.60 |
| Rate for Payer: Aetna Commercial |
$594.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.55
|
| Rate for Payer: Cash Price |
$386.25
|
| Rate for Payer: Cigna Commercial |
$641.17
|
| Rate for Payer: First Health Commercial |
$733.88
|
| Rate for Payer: Humana Commercial |
$656.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$570.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.80
|
| Rate for Payer: Ohio Health Group HMO |
$579.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.02
|
| Rate for Payer: PHCS Commercial |
$741.60
|
| Rate for Payer: United Healthcare All Payer |
$679.80
|
|
|
SHEETING SILICONE 2*3*.020
|
Facility
|
OP
|
$772.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$741.60 |
| Rate for Payer: Aetna Commercial |
$594.83
|
| Rate for Payer: Anthem Medicaid |
$265.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.55
|
| Rate for Payer: Cash Price |
$386.25
|
| Rate for Payer: Cigna Commercial |
$641.17
|
| Rate for Payer: First Health Commercial |
$733.88
|
| Rate for Payer: Humana Commercial |
$656.62
|
| Rate for Payer: Humana KY Medicaid |
$265.66
|
| Rate for Payer: Kentucky WC Medicaid |
$268.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$570.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.80
|
| Rate for Payer: Ohio Health Group HMO |
$579.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.02
|
| Rate for Payer: PHCS Commercial |
$741.60
|
| Rate for Payer: United Healthcare All Payer |
$679.80
|
|
|
SHEETING SILICONE 8*6*.020
|
Facility
|
IP
|
$1,900.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.12 |
| Max. Negotiated Rate |
$1,824.38 |
| Rate for Payer: Aetna Commercial |
$1,463.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.31
|
| Rate for Payer: Cash Price |
$950.20
|
| Rate for Payer: Cigna Commercial |
$1,577.33
|
| Rate for Payer: First Health Commercial |
$1,805.38
|
| Rate for Payer: Humana Commercial |
$1,615.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.28
|
| Rate for Payer: PHCS Commercial |
$1,824.38
|
| Rate for Payer: United Healthcare All Payer |
$1,672.35
|
|
|
SHEETING SILICONE 8*6*.020
|
Facility
|
OP
|
$1,900.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.12 |
| Max. Negotiated Rate |
$1,824.38 |
| Rate for Payer: Aetna Commercial |
$1,463.31
|
| Rate for Payer: Anthem Medicaid |
$653.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.31
|
| Rate for Payer: Cash Price |
$950.20
|
| Rate for Payer: Cigna Commercial |
$1,577.33
|
| Rate for Payer: First Health Commercial |
$1,805.38
|
| Rate for Payer: Humana Commercial |
$1,615.34
|
| Rate for Payer: Humana KY Medicaid |
$653.55
|
| Rate for Payer: Kentucky WC Medicaid |
$660.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.28
|
| Rate for Payer: PHCS Commercial |
$1,824.38
|
| Rate for Payer: United Healthcare All Payer |
$1,672.35
|
|
|
SHELL CONT CLUSTER HOLE 44EE
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
SHELL CONT CLUSTER HOLE 44EE
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
