|
METACROSS OTW 6*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 6*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 6*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 6*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 6*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 6*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: 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 6*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 6*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 6*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 6*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 6*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 8*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 8*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 8*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 8*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 8*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 8*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 8*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 8*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
|
|
|
METAGLENE LONG PEG +10MM
|
Facility
|
IP
|
$16,537.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,149.84 |
| Max. Negotiated Rate |
$15,875.71 |
| Rate for Payer: Aetna Commercial |
$12,733.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,899.02
|
| Rate for Payer: Cash Price |
$8,268.60
|
| Rate for Payer: Cigna Commercial |
$13,725.88
|
| Rate for Payer: First Health Commercial |
$15,710.34
|
| Rate for Payer: Humana Commercial |
$14,056.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,560.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,204.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,961.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,552.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,402.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,307.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,149.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,126.53
|
| Rate for Payer: PHCS Commercial |
$15,875.71
|
| Rate for Payer: United Healthcare All Payer |
$14,552.74
|
|
|
METAGLENE LONG PEG +10MM
|
Facility
|
OP
|
$16,537.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,149.84 |
| Max. Negotiated Rate |
$15,875.71 |
| Rate for Payer: Aetna Commercial |
$12,733.64
|
| Rate for Payer: Anthem Medicaid |
$5,687.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,899.02
|
| Rate for Payer: Cash Price |
$8,268.60
|
| Rate for Payer: Cigna Commercial |
$13,725.88
|
| Rate for Payer: First Health Commercial |
$15,710.34
|
| Rate for Payer: Humana Commercial |
$14,056.62
|
| Rate for Payer: Humana KY Medicaid |
$5,687.14
|
| Rate for Payer: Kentucky WC Medicaid |
$5,745.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,560.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,204.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,961.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,801.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,552.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,402.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,307.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,149.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,126.53
|
| Rate for Payer: PHCS Commercial |
$15,875.71
|
| Rate for Payer: United Healthcare All Payer |
$14,552.74
|
|
|
METAGLENE LONG PEG +15MM
|
Facility
|
IP
|
$16,537.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,149.84 |
| Max. Negotiated Rate |
$15,875.71 |
| Rate for Payer: Aetna Commercial |
$12,733.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,899.02
|
| Rate for Payer: Cash Price |
$8,268.60
|
| Rate for Payer: Cigna Commercial |
$13,725.88
|
| Rate for Payer: First Health Commercial |
$15,710.34
|
| Rate for Payer: Humana Commercial |
$14,056.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,560.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,204.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,961.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,552.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,402.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,307.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,149.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,126.53
|
| Rate for Payer: PHCS Commercial |
$15,875.71
|
| Rate for Payer: United Healthcare All Payer |
$14,552.74
|
|
|
METAGLENE LONG PEG +15MM
|
Facility
|
OP
|
$16,537.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,149.84 |
| Max. Negotiated Rate |
$15,875.71 |
| Rate for Payer: Aetna Commercial |
$12,733.64
|
| Rate for Payer: Anthem Medicaid |
$5,687.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,899.02
|
| Rate for Payer: Cash Price |
$8,268.60
|
| Rate for Payer: Cigna Commercial |
$13,725.88
|
| Rate for Payer: First Health Commercial |
$15,710.34
|
| Rate for Payer: Humana Commercial |
$14,056.62
|
| Rate for Payer: Humana KY Medicaid |
$5,687.14
|
| Rate for Payer: Kentucky WC Medicaid |
$5,745.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,560.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,204.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,961.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,801.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,552.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,402.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,307.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,149.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,126.53
|
| Rate for Payer: PHCS Commercial |
$15,875.71
|
| Rate for Payer: United Healthcare All Payer |
$14,552.74
|
|
|
METAGLENE STANDARD V3.2
|
Facility
|
IP
|
$11,972.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.41 |
| Max. Negotiated Rate |
$11,493.50 |
| Rate for Payer: Aetna Commercial |
$9,218.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,338.47
|
| Rate for Payer: Cash Price |
$5,986.20
|
| Rate for Payer: Cigna Commercial |
$9,937.09
|
| Rate for Payer: First Health Commercial |
$11,373.78
|
| Rate for Payer: Humana Commercial |
$10,176.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,817.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,835.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,591.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,535.71
|
| Rate for Payer: Ohio Health Group HMO |
$8,979.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,394.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,556.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,711.44
|
| Rate for Payer: PHCS Commercial |
$11,493.50
|
| Rate for Payer: United Healthcare All Payer |
$10,535.71
|
|
|
METAGLENE STANDARD V3.2
|
Facility
|
OP
|
$11,972.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.41 |
| Max. Negotiated Rate |
$11,493.50 |
| Rate for Payer: Aetna Commercial |
$9,218.75
|
| Rate for Payer: Anthem Medicaid |
$4,117.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,338.47
|
| Rate for Payer: Cash Price |
$5,986.20
|
| Rate for Payer: Cigna Commercial |
$9,937.09
|
| Rate for Payer: First Health Commercial |
$11,373.78
|
| Rate for Payer: Humana Commercial |
$10,176.54
|
| Rate for Payer: Humana KY Medicaid |
$4,117.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,159.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,817.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,835.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,591.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,199.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,535.71
|
| Rate for Payer: Ohio Health Group HMO |
$8,979.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,394.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,556.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,711.44
|
| Rate for Payer: PHCS Commercial |
$11,493.50
|
| Rate for Payer: United Healthcare All Payer |
$10,535.71
|
|
