SAFESHEATH 10 FR CLS-1010
|
Facility
|
OP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem Medicaid |
$532.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Humana KY Medicaid |
$532.19
|
Rate for Payer: Kentucky WC Medicaid |
$537.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 10 FR CLS-1010
|
Facility
|
IP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 11.5 FR CLS-1011.5
|
Facility
|
OP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem Medicaid |
$532.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Humana KY Medicaid |
$532.19
|
Rate for Payer: Kentucky WC Medicaid |
$537.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 11.5 FR CLS-1011.5
|
Facility
|
IP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 11FR CLS-1011
|
Facility
|
IP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 11FR CLS-1011
|
Facility
|
OP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem Medicaid |
$532.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Humana KY Medicaid |
$532.19
|
Rate for Payer: Kentucky WC Medicaid |
$537.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 11FR HLS-1011M
|
Facility
|
OP
|
$1,129.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$146.84 |
Max. Negotiated Rate |
$1,084.32 |
Rate for Payer: Aetna Commercial |
$869.72
|
Rate for Payer: Anthem Medicaid |
$388.44
|
Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
Rate for Payer: Cash Price |
$564.75
|
Rate for Payer: Cigna Commercial |
$937.48
|
Rate for Payer: First Health Commercial |
$1,073.02
|
Rate for Payer: Humana Commercial |
$960.08
|
Rate for Payer: Humana KY Medicaid |
$388.44
|
Rate for Payer: Kentucky WC Medicaid |
$392.39
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
Rate for Payer: Molina Healthcare Medicaid |
$396.23
|
Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
Rate for Payer: Ohio Health Group HMO |
$847.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
Rate for Payer: PHCS Commercial |
$1,084.32
|
Rate for Payer: United Healthcare All Payer |
$993.96
|
|
SAFESHEATH 11FR HLS-1011M
|
Facility
|
IP
|
$1,129.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$146.84 |
Max. Negotiated Rate |
$1,084.32 |
Rate for Payer: Aetna Commercial |
$869.72
|
Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
Rate for Payer: Cash Price |
$564.75
|
Rate for Payer: Cigna Commercial |
$937.48
|
Rate for Payer: First Health Commercial |
$1,073.02
|
Rate for Payer: Humana Commercial |
$960.08
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
Rate for Payer: Ohio Health Group HMO |
$847.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
Rate for Payer: PHCS Commercial |
$1,084.32
|
Rate for Payer: United Healthcare All Payer |
$993.96
|
|
SAFESHEATH 12 FR CLS-1012
|
Facility
|
OP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem Medicaid |
$532.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Humana KY Medicaid |
$532.19
|
Rate for Payer: Kentucky WC Medicaid |
$537.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 12 FR CLS-1012
|
Facility
|
IP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 6.5 FR CLS-1006.5
|
Facility
|
IP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 6.5 FR CLS-1006.5
|
Facility
|
OP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem Medicaid |
$532.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Humana KY Medicaid |
$532.19
|
Rate for Payer: Kentucky WC Medicaid |
$537.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 6FR CLS-1006
|
Facility
|
OP
|
$1,547.50
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
27000112
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem Medicaid |
$532.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Humana KY Medicaid |
$532.19
|
Rate for Payer: Kentucky WC Medicaid |
$537.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 6FR CLS-1006
|
Facility
|
IP
|
$1,547.50
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
27000112
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 6FR HLS-1006M
|
Facility
|
IP
|
$1,129.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$146.84 |
Max. Negotiated Rate |
$1,084.32 |
Rate for Payer: Aetna Commercial |
$869.72
|
Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
Rate for Payer: Cash Price |
$564.75
|
Rate for Payer: Cigna Commercial |
$937.48
|
Rate for Payer: First Health Commercial |
$1,073.02
|
Rate for Payer: Humana Commercial |
$960.08
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
Rate for Payer: Ohio Health Group HMO |
$847.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
Rate for Payer: PHCS Commercial |
$1,084.32
|
Rate for Payer: United Healthcare All Payer |
$993.96
|
|
SAFESHEATH 6FR HLS-1006M
|
Facility
|
OP
|
$1,129.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$146.84 |
Max. Negotiated Rate |
$1,084.32 |
Rate for Payer: Aetna Commercial |
$869.72
|
Rate for Payer: Anthem Medicaid |
$388.44
|
Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
Rate for Payer: Cash Price |
$564.75
|
Rate for Payer: Cigna Commercial |
$937.48
|
Rate for Payer: First Health Commercial |
$1,073.02
|
Rate for Payer: Humana Commercial |
$960.08
|
Rate for Payer: Humana KY Medicaid |
$388.44
|
Rate for Payer: Kentucky WC Medicaid |
$392.39
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
Rate for Payer: Molina Healthcare Medicaid |
$396.23
|
Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
Rate for Payer: Ohio Health Group HMO |
$847.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
Rate for Payer: PHCS Commercial |
$1,084.32
|
Rate for Payer: United Healthcare All Payer |
$993.96
|
|
SAFESHEATH 6FR W/SIDE PORT
|
Facility
|
OP
|
$1,065.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$138.45 |
Max. Negotiated Rate |
$1,022.40 |
Rate for Payer: Aetna Commercial |
$820.05
|
Rate for Payer: Anthem Medicaid |
$366.25
|
Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
Rate for Payer: Cash Price |
$532.50
|
Rate for Payer: Cigna Commercial |
$883.95
|
Rate for Payer: First Health Commercial |
$1,011.75
|
Rate for Payer: Humana Commercial |
$905.25
|
Rate for Payer: Humana KY Medicaid |
$366.25
|
Rate for Payer: Kentucky WC Medicaid |
$369.98
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
Rate for Payer: Ohio Health Group HMO |
$798.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
Rate for Payer: PHCS Commercial |
$1,022.40
|
Rate for Payer: United Healthcare All Payer |
$937.20
|
|
SAFESHEATH 6FR W/SIDE PORT
|
Facility
|
IP
|
$1,065.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$138.45 |
Max. Negotiated Rate |
$1,022.40 |
Rate for Payer: Aetna Commercial |
$820.05
|
Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
Rate for Payer: Cash Price |
$532.50
|
Rate for Payer: Cigna Commercial |
$883.95
|
Rate for Payer: First Health Commercial |
$1,011.75
|
Rate for Payer: Humana Commercial |
$905.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
Rate for Payer: Ohio Health Group HMO |
$798.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
Rate for Payer: PHCS Commercial |
$1,022.40
|
Rate for Payer: United Healthcare All Payer |
$937.20
|
|
SAFESHEATH 7.5 FR CLS-1007.5
|
Facility
|
IP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 7.5 FR CLS-1007.5
|
Facility
|
OP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem Medicaid |
$532.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Humana KY Medicaid |
$532.19
|
Rate for Payer: Kentucky WC Medicaid |
$537.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFE SHEATH 7FR 7115
|
Facility
|
IP
|
$1,512.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$196.62 |
Max. Negotiated Rate |
$1,452.00 |
Rate for Payer: Aetna Commercial |
$1,164.62
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
Rate for Payer: Cash Price |
$756.25
|
Rate for Payer: Cigna Commercial |
$1,255.38
|
Rate for Payer: First Health Commercial |
$1,436.88
|
Rate for Payer: Humana Commercial |
$1,285.62
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
Rate for Payer: PHCS Commercial |
$1,452.00
|
Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
SAFE SHEATH 7FR 7115
|
Facility
|
OP
|
$1,512.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$196.62 |
Max. Negotiated Rate |
$1,452.00 |
Rate for Payer: Aetna Commercial |
$1,164.62
|
Rate for Payer: Anthem Medicaid |
$520.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
Rate for Payer: Cash Price |
$756.25
|
Rate for Payer: Cigna Commercial |
$1,255.38
|
Rate for Payer: First Health Commercial |
$1,436.88
|
Rate for Payer: Humana Commercial |
$1,285.62
|
Rate for Payer: Humana KY Medicaid |
$520.15
|
Rate for Payer: Kentucky WC Medicaid |
$525.44
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
Rate for Payer: Molina Healthcare Medicaid |
$530.58
|
Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
Rate for Payer: PHCS Commercial |
$1,452.00
|
Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
SAFESHEATH 7FR CLS-1007
|
Facility
|
IP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 7FR CLS-1007
|
Facility
|
OP
|
$1,547.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$201.18 |
Max. Negotiated Rate |
$1,485.60 |
Rate for Payer: Aetna Commercial |
$1,191.58
|
Rate for Payer: Anthem Medicaid |
$532.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
Rate for Payer: Cash Price |
$773.75
|
Rate for Payer: Cigna Commercial |
$1,284.42
|
Rate for Payer: First Health Commercial |
$1,470.12
|
Rate for Payer: Humana Commercial |
$1,315.38
|
Rate for Payer: Humana KY Medicaid |
$532.19
|
Rate for Payer: Kentucky WC Medicaid |
$537.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
Rate for Payer: PHCS Commercial |
$1,485.60
|
Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
SAFESHEATH 7FR HLS1007
|
Facility
|
OP
|
$1,129.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$146.84 |
Max. Negotiated Rate |
$1,084.32 |
Rate for Payer: Aetna Commercial |
$869.72
|
Rate for Payer: Anthem Medicaid |
$388.44
|
Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
Rate for Payer: Cash Price |
$564.75
|
Rate for Payer: Cigna Commercial |
$937.48
|
Rate for Payer: First Health Commercial |
$1,073.02
|
Rate for Payer: Humana Commercial |
$960.08
|
Rate for Payer: Humana KY Medicaid |
$388.44
|
Rate for Payer: Kentucky WC Medicaid |
$392.39
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
Rate for Payer: Molina Healthcare Medicaid |
$396.23
|
Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
Rate for Payer: Ohio Health Group HMO |
$847.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
Rate for Payer: PHCS Commercial |
$1,084.32
|
Rate for Payer: United Healthcare All Payer |
$993.96
|
|