|
MESTINON TMSP 180 MG TABLET
|
Facility
|
IP
|
$76.33
|
|
|
Service Code
|
NDC 187301330
|
| Hospital Charge Code |
25000964
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$73.28 |
| Rate for Payer: Aetna Commercial |
$58.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.54
|
| Rate for Payer: Cash Price |
$38.16
|
| Rate for Payer: Cigna Commercial |
$63.35
|
| Rate for Payer: First Health Commercial |
$72.51
|
| Rate for Payer: Humana Commercial |
$64.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.17
|
| Rate for Payer: Ohio Health Group HMO |
$57.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.66
|
| Rate for Payer: PHCS Commercial |
$73.28
|
| Rate for Payer: United Healthcare All Payer |
$67.17
|
|
|
METACROSS OTW 10*20*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 10*20*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 10*40*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 10*40*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 10*60*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 10*60*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 10*80*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 10*80*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 12*20*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 12*20*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 12*40*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 12*40*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 4*100*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 4*100*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 4*120*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
| Rate for Payer: Aetna Commercial |
$1,346.73
|
|
|
METACROSS OTW 4*120*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 4*150*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 4*150*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 4*200*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 4*200*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 4*20*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 4*20*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 4*40*135
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
|
METACROSS OTW 4*40*135
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.37 |
| Max. Negotiated Rate |
$1,679.04 |
| Rate for Payer: Aetna Commercial |
$1,346.73
|
| Rate for Payer: Anthem Medicaid |
$601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,364.22
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna Commercial |
$1,451.67
|
| Rate for Payer: First Health Commercial |
$1,661.55
|
| Rate for Payer: Humana Commercial |
$1,486.65
|
| Rate for Payer: Humana KY Medicaid |
$601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$607.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,434.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,539.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.19
|
| Rate for Payer: PHCS Commercial |
$1,679.04
|
| Rate for Payer: United Healthcare All Payer |
$1,539.12
|
|
