|
STERLING BALLOON 3*6*135
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 3*6*135
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*15*80
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*15*80
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*20*135 OTW
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*20*135 OTW
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*2*80 OTW
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*2*80 OTW
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*30*135
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*30*135
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*40*135 OTW
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*40*135 OTW
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*60*80 OTW
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*60*80 OTW
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*6*135
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*6*135
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*8*135
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 4*8*135
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 5*100*135 OTW
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 5*100*135 OTW
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 5*15*80
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem Medicaid |
$1,023.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
STERLING BALLOON 5*15*80
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
STERLING BALLOON 5*20*135 OTW
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 5*20*135 OTW
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
STERLING BALLOON 5*2*80
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
