|
SHEATH AV ACCESS TUN CVD
|
Facility
|
OP
|
$1,126.06
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.39 |
| Max. Negotiated Rate |
$1,081.02 |
| Rate for Payer: Aetna Commercial |
$867.07
|
| Rate for Payer: Anthem Medicaid |
$387.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.33
|
| Rate for Payer: Cash Price |
$563.03
|
| Rate for Payer: Cigna Commercial |
$934.63
|
| Rate for Payer: First Health Commercial |
$1,069.76
|
| Rate for Payer: Humana Commercial |
$957.15
|
| Rate for Payer: Humana KY Medicaid |
$387.25
|
| Rate for Payer: Kentucky WC Medicaid |
$391.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$831.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.93
|
| Rate for Payer: Ohio Health Group HMO |
$844.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.08
|
| Rate for Payer: PHCS Commercial |
$1,081.02
|
| Rate for Payer: United Healthcare All Payer |
$990.93
|
|
|
SHEATH AV ACCESS TUN CVD
|
Facility
|
IP
|
$1,126.06
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.39 |
| Max. Negotiated Rate |
$1,081.02 |
| Rate for Payer: Aetna Commercial |
$867.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.33
|
| Rate for Payer: Cash Price |
$563.03
|
| Rate for Payer: Cigna Commercial |
$934.63
|
| Rate for Payer: First Health Commercial |
$1,069.76
|
| Rate for Payer: Humana Commercial |
$957.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$831.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.93
|
| Rate for Payer: Ohio Health Group HMO |
$844.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.08
|
| Rate for Payer: PHCS Commercial |
$1,081.02
|
| Rate for Payer: United Healthcare All Payer |
$990.93
|
|
|
SHEATH BIO-INTRAFIX 9*30
|
Facility
|
OP
|
$1,948.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,870.56 |
| Rate for Payer: Aetna Commercial |
$1,500.34
|
| Rate for Payer: Anthem Medicaid |
$670.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.83
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cigna Commercial |
$1,617.26
|
| Rate for Payer: First Health Commercial |
$1,851.08
|
| Rate for Payer: Humana Commercial |
$1,656.22
|
| Rate for Payer: Humana KY Medicaid |
$670.09
|
| Rate for Payer: Kentucky WC Medicaid |
$676.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,437.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.04
|
| Rate for Payer: PHCS Commercial |
$1,870.56
|
| Rate for Payer: United Healthcare All Payer |
$1,714.68
|
|
|
SHEATH BIO-INTRAFIX 9*30
|
Facility
|
IP
|
$1,948.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,870.56 |
| Rate for Payer: Aetna Commercial |
$1,500.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.83
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cigna Commercial |
$1,617.26
|
| Rate for Payer: First Health Commercial |
$1,851.08
|
| Rate for Payer: Humana Commercial |
$1,656.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,437.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.04
|
| Rate for Payer: PHCS Commercial |
$1,870.56
|
| Rate for Payer: United Healthcare All Payer |
$1,714.68
|
|
|
SHEATH CHECK-FLO 14*30
|
Facility
|
OP
|
$1,812.28
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.60 |
| Max. Negotiated Rate |
$1,739.79 |
| Rate for Payer: Aetna Commercial |
$1,395.46
|
| Rate for Payer: Anthem Medicaid |
$623.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,413.58
|
| Rate for Payer: Cash Price |
$906.14
|
| Rate for Payer: Cigna Commercial |
$1,504.19
|
| Rate for Payer: First Health Commercial |
$1,721.67
|
| Rate for Payer: Humana Commercial |
$1,540.44
|
| Rate for Payer: Humana KY Medicaid |
$623.24
|
| Rate for Payer: Kentucky WC Medicaid |
$629.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$635.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.81
|
| Rate for Payer: PHCS Commercial |
$1,739.79
|
| Rate for Payer: United Healthcare All Payer |
$1,594.81
|
|
|
SHEATH CHECK-FLO 14*30
|
Facility
|
IP
|
$1,812.28
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.60 |
| Max. Negotiated Rate |
$1,739.79 |
| Rate for Payer: Aetna Commercial |
$1,395.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,413.58
|
| Rate for Payer: Cash Price |
$906.14
|
| Rate for Payer: Cigna Commercial |
$1,504.19
|
| Rate for Payer: First Health Commercial |
$1,721.67
|
| Rate for Payer: Humana Commercial |
$1,540.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.81
|
| Rate for Payer: PHCS Commercial |
$1,739.79
|
| Rate for Payer: United Healthcare All Payer |
$1,594.81
|
|
|
SHEATH CLASSIC 7FR CLS-2507
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.09 |
| Max. Negotiated Rate |
$1,529.28 |
| Rate for Payer: Aetna Commercial |
$1,226.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,242.54
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna Commercial |
$1,322.19
|
| Rate for Payer: First Health Commercial |
$1,513.35
|
| Rate for Payer: Humana Commercial |
$1,354.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,306.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,175.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,401.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,194.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.83
|
| Rate for Payer: PHCS Commercial |
$1,529.28
|
| Rate for Payer: United Healthcare All Payer |
$1,401.84
|
|
|
SHEATH CLASSIC 7FR CLS-2507
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.09 |
| Max. Negotiated Rate |
$1,529.28 |
| Rate for Payer: Aetna Commercial |
$1,226.61
|
| Rate for Payer: Anthem Medicaid |
$547.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,242.54
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna Commercial |
$1,322.19
|
| Rate for Payer: First Health Commercial |
$1,513.35
|
| Rate for Payer: Humana Commercial |
$1,354.05
|
| Rate for Payer: Humana KY Medicaid |
$547.83
|
| Rate for Payer: Kentucky WC Medicaid |
$553.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,306.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,175.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$558.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,401.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,194.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.83
|
| Rate for Payer: PHCS Commercial |
$1,529.28
|
| Rate for Payer: United Healthcare All Payer |
$1,401.84
|
|
|
SHEATH CLEAR
|
Facility
|
IP
|
$822.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.96 |
| Max. Negotiated Rate |
$789.84 |
| Rate for Payer: Aetna Commercial |
$633.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$641.74
|
| Rate for Payer: Cash Price |
$411.38
|
| Rate for Payer: Cigna Commercial |
$682.88
|
| Rate for Payer: First Health Commercial |
$781.61
|
| Rate for Payer: Humana Commercial |
$699.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$674.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$607.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$724.02
|
| Rate for Payer: Ohio Health Group HMO |
$617.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.05
|
| Rate for Payer: PHCS Commercial |
$789.84
|
| Rate for Payer: United Healthcare All Payer |
$724.02
|
|
|
SHEATH CLEAR
|
Facility
|
OP
|
$822.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.96 |
| Max. Negotiated Rate |
$789.84 |
| Rate for Payer: Aetna Commercial |
$633.52
|
| Rate for Payer: Anthem Medicaid |
$282.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$641.74
|
| Rate for Payer: Cash Price |
$411.38
|
| Rate for Payer: Cigna Commercial |
$682.88
|
| Rate for Payer: First Health Commercial |
$781.61
|
| Rate for Payer: Humana Commercial |
$699.34
|
| Rate for Payer: Humana KY Medicaid |
$282.94
|
| Rate for Payer: Kentucky WC Medicaid |
$285.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$674.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$607.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$288.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$724.02
|
| Rate for Payer: Ohio Health Group HMO |
$617.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.05
|
| Rate for Payer: PHCS Commercial |
$789.84
|
| Rate for Payer: United Healthcare All Payer |
$724.02
|
|
|
SHEATH CPS DIRECT PL 410171
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410171
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410172
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410172
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410173
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410173
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410174
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410174
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410175
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410175
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410176
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410176
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410180
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410180
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
SHEATH CPS DIRECT PL 410181
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
