|
SAPPHIRE II PRO SZ 1.00*8
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
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
|
|
|
SAPPHIRE II PRO SZ 1.25*10
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.25*10
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.25*15
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.25*15
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.25*5
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.25*5
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.25*8
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.25*8
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.50*10
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.50*10
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.50*12
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.50*12
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.50*15
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.50*15
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.50*20
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.50*20
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.75*10
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.75*10
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.75*15
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.75*15
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.75*20
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 1.75*20
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 2.00*10
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
SAPPHIRE II PRO SZ 2.00*10
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
