|
STERLING MONORAIL 8*2*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 MONORAIL 8*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
|
|
|
STERLING MONORAIL 8*30*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 MONORAIL 8*30*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 MONORAIL 8*4*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 MONORAIL 8*4*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 MONORAIL 8*6 CATH
|
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 MONORAIL 8*6 CATH
|
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 OTW 5*150
|
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 OTW 5*150
|
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 OTW 5*200
|
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 OTW 5*200
|
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 OTW 5*220
|
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 OTW 5*220
|
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 OTW BALLOON 8*20*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 OTW BALLOON 8*20*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 SL OTW 2*100*150
|
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 SL OTW 2*100*150
|
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 SL OTW 2*120*150
|
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 SL OTW 2*120*150
|
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 SL OTW 2*150*150
|
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 SL OTW 2*150*150
|
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 SL OTW 2.5*100*150
|
Facility
|
IP
|
$3,368.38
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,010.51 |
| Max. Negotiated Rate |
$3,233.64 |
| Rate for Payer: Aetna Commercial |
$2,593.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.34
|
| Rate for Payer: Cash Price |
$1,684.19
|
| Rate for Payer: Cigna Commercial |
$2,795.76
|
| Rate for Payer: First Health Commercial |
$3,199.96
|
| Rate for Payer: Humana Commercial |
$2,863.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.17
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,694.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.18
|
| Rate for Payer: PHCS Commercial |
$3,233.64
|
| Rate for Payer: United Healthcare All Payer |
$2,964.17
|
|
|
STERLING SL OTW 2.5*100*150
|
Facility
|
OP
|
$3,368.38
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,010.51 |
| Max. Negotiated Rate |
$3,233.64 |
| Rate for Payer: Aetna Commercial |
$2,593.65
|
| Rate for Payer: Anthem Medicaid |
$1,158.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.34
|
| Rate for Payer: Cash Price |
$1,684.19
|
| Rate for Payer: Cigna Commercial |
$2,795.76
|
| Rate for Payer: First Health Commercial |
$3,199.96
|
| Rate for Payer: Humana Commercial |
$2,863.12
|
| Rate for Payer: Humana KY Medicaid |
$1,158.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,170.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,181.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.17
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,694.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.18
|
| Rate for Payer: PHCS Commercial |
$3,233.64
|
| Rate for Payer: United Healthcare All Payer |
$2,964.17
|
|
|
STERLING SL OTW 2.5*120*150
|
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
|
|
