|
STERLING SL OTW 2.5*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 2.5*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 2.5*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*80*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*80*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*80*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*80*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 3*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 3*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 3*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 3*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 3*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 3*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 3*80*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 3*80*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 4*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 4*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 4*120*150
|
Facility
|
OP
|
$3,573.65
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,072.10 |
| Max. Negotiated Rate |
$3,430.70 |
| Rate for Payer: Aetna Commercial |
$2,751.71
|
| Rate for Payer: Anthem Medicaid |
$1,228.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,787.45
|
| Rate for Payer: Cash Price |
$1,786.83
|
| Rate for Payer: Cigna Commercial |
$2,966.13
|
| Rate for Payer: First Health Commercial |
$3,394.97
|
| Rate for Payer: Humana Commercial |
$3,037.60
|
| Rate for Payer: Humana KY Medicaid |
$1,228.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,241.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,930.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,637.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,253.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,144.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,680.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,858.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,109.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,465.82
|
| Rate for Payer: PHCS Commercial |
$3,430.70
|
| Rate for Payer: United Healthcare All Payer |
$3,144.81
|
|
|
STERLING SL OTW 4*120*150
|
Facility
|
IP
|
$3,573.65
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,072.10 |
| Max. Negotiated Rate |
$3,430.70 |
| Rate for Payer: Aetna Commercial |
$2,751.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,787.45
|
| Rate for Payer: Cash Price |
$1,786.83
|
| Rate for Payer: Cigna Commercial |
$2,966.13
|
| Rate for Payer: First Health Commercial |
$3,394.97
|
| Rate for Payer: Humana Commercial |
$3,037.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,930.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,637.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,144.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,680.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,858.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,109.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,465.82
|
| Rate for Payer: PHCS Commercial |
$3,430.70
|
| Rate for Payer: United Healthcare All Payer |
$3,144.81
|
|
|
STERLING SL OTW 4*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 4*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 4*80*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 4*80*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
|
|
|
STERNAL DEBRIDEMENT
|
Facility
|
OP
|
$2,545.00
|
|
|
Service Code
|
HCPCS 21627
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$763.50 |
| Max. Negotiated Rate |
$2,443.20 |
| Rate for Payer: Aetna Commercial |
$1,959.65
|
| Rate for Payer: Anthem Medicaid |
$875.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,985.10
|
| Rate for Payer: Cash Price |
$1,272.50
|
| Rate for Payer: Cigna Commercial |
$2,112.35
|
| Rate for Payer: First Health Commercial |
$2,417.75
|
| Rate for Payer: Humana Commercial |
$2,163.25
|
| Rate for Payer: Humana KY Medicaid |
$875.23
|
| Rate for Payer: Kentucky WC Medicaid |
$884.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,086.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,878.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$763.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$892.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,239.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,908.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,214.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,756.05
|
| Rate for Payer: PHCS Commercial |
$2,443.20
|
| Rate for Payer: United Healthcare All Payer |
$2,239.60
|
|
|
STERNAL DEBRIDEMENT
|
Facility
|
IP
|
$2,545.00
|
|
|
Service Code
|
HCPCS 21627
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$763.50 |
| Max. Negotiated Rate |
$2,443.20 |
| Rate for Payer: Aetna Commercial |
$1,959.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,985.10
|
| Rate for Payer: Cash Price |
$1,272.50
|
| Rate for Payer: Cigna Commercial |
$2,112.35
|
| Rate for Payer: First Health Commercial |
$2,417.75
|
| Rate for Payer: Humana Commercial |
$2,163.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,086.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,878.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$763.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,239.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,908.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,214.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,756.05
|
| Rate for Payer: PHCS Commercial |
$2,443.20
|
| Rate for Payer: United Healthcare All Payer |
$2,239.60
|
|
