|
METACROSS OTW 4*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 4*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 4*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 4*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 5*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 5*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: 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
|
| 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
|
|
|
METACROSS OTW 5*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: 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 5*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 5*150*135
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
METACROSS OTW 5*150*135
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
METACROSS OTW 5*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 5*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 5*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 5*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: 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
|
| 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
|
|
|
METACROSS OTW 5*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 5*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 5*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 5*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 5*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 5*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 6*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 6*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 6*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 6*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: 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 6*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
|
|
