|
MESH XENMATRIX 20*25CM
|
Facility
|
IP
|
$81,860.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,558.06 |
| Max. Negotiated Rate |
$78,585.79 |
| Rate for Payer: Aetna Commercial |
$63,032.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,850.96
|
| Rate for Payer: Cash Price |
$40,930.10
|
| Rate for Payer: Cigna Commercial |
$67,943.97
|
| Rate for Payer: First Health Commercial |
$77,767.19
|
| Rate for Payer: Humana Commercial |
$69,581.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,125.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,412.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,558.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,036.98
|
| Rate for Payer: Ohio Health Group HMO |
$61,395.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,488.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,483.54
|
| Rate for Payer: PHCS Commercial |
$78,585.79
|
| Rate for Payer: United Healthcare All Payer |
$72,036.98
|
|
|
MESH Y UPSYLON
|
Facility
|
IP
|
$5,279.15
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,583.74 |
| Max. Negotiated Rate |
$5,067.98 |
| Rate for Payer: Aetna Commercial |
$4,064.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,117.74
|
| Rate for Payer: Cash Price |
$2,639.57
|
| Rate for Payer: Cigna Commercial |
$4,381.69
|
| Rate for Payer: First Health Commercial |
$5,015.19
|
| Rate for Payer: Humana Commercial |
$4,487.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,328.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,583.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,645.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,959.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,223.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,592.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,642.61
|
| Rate for Payer: PHCS Commercial |
$5,067.98
|
| Rate for Payer: United Healthcare All Payer |
$4,645.65
|
|
|
MESH Y UPSYLON
|
Facility
|
OP
|
$5,279.15
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,583.74 |
| Max. Negotiated Rate |
$5,067.98 |
| Rate for Payer: Aetna Commercial |
$4,064.95
|
| Rate for Payer: Anthem Medicaid |
$1,815.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,117.74
|
| Rate for Payer: Cash Price |
$2,639.57
|
| Rate for Payer: Cigna Commercial |
$4,381.69
|
| Rate for Payer: First Health Commercial |
$5,015.19
|
| Rate for Payer: Humana Commercial |
$4,487.28
|
| Rate for Payer: Humana KY Medicaid |
$1,815.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,833.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,328.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,583.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,851.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,645.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,959.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,223.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,592.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,642.61
|
| Rate for Payer: PHCS Commercial |
$5,067.98
|
| Rate for Payer: United Healthcare All Payer |
$4,645.65
|
|
|
MESNEX 400 MG TABLET
|
Facility
|
OP
|
$150.59
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
25003209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$144.57 |
| Rate for Payer: Aetna Commercial |
$115.95
|
| Rate for Payer: Anthem Medicaid |
$51.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.46
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$124.99
|
| Rate for Payer: First Health Commercial |
$143.06
|
| Rate for Payer: Humana Commercial |
$128.00
|
| Rate for Payer: Humana KY Medicaid |
$51.79
|
| Rate for Payer: Kentucky WC Medicaid |
$52.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.52
|
| Rate for Payer: Ohio Health Group HMO |
$112.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$131.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.91
|
| Rate for Payer: PHCS Commercial |
$144.57
|
| Rate for Payer: United Healthcare All Payer |
$132.52
|
|
|
MESNEX 400 MG TABLET
|
Facility
|
IP
|
$150.59
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
25003209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$144.57 |
| Rate for Payer: Aetna Commercial |
$115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.46
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$124.99
|
| Rate for Payer: First Health Commercial |
$143.06
|
| Rate for Payer: Humana Commercial |
$128.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.52
|
| Rate for Payer: Ohio Health Group HMO |
$112.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$131.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.91
|
| Rate for Payer: PHCS Commercial |
$144.57
|
| Rate for Payer: United Healthcare All Payer |
$132.52
|
|
|
MESNEX(MESNA)200MG(1000MG/10ML
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
25002630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$37.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Humana KY Medicaid |
$37.49
|
| Rate for Payer: Kentucky WC Medicaid |
$37.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
MESNEX(MESNA)200MG(1000MG/10ML
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
25002630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
MESTINON (PYRIDOSTIG 60MG/1TAB
|
Facility
|
OP
|
$9.38
|
|
|
Service Code
|
NDC 68084049401
|
| Hospital Charge Code |
25000963
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Anthem Medicaid |
$3.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.32
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cigna Commercial |
$7.79
|
| Rate for Payer: First Health Commercial |
$8.91
|
| Rate for Payer: Humana Commercial |
$7.97
|
| Rate for Payer: Humana KY Medicaid |
$3.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.25
|
| Rate for Payer: Ohio Health Group HMO |
$7.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.47
|
| Rate for Payer: PHCS Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Payer |
$8.25
|
|
|
MESTINON (PYRIDOSTIG 60MG/1TAB
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
NDC 68084049401
|
| Hospital Charge Code |
25000963
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.32
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cigna Commercial |
$7.79
|
| Rate for Payer: First Health Commercial |
$8.91
|
| Rate for Payer: Humana Commercial |
$7.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.25
|
| Rate for Payer: Ohio Health Group HMO |
$7.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.47
|
| Rate for Payer: PHCS Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Payer |
$8.25
|
|
|
MESTINON TMSP 180 MG TABLET
|
Facility
|
OP
|
$79.01
|
|
|
Service Code
|
NDC 187301330
|
| Hospital Charge Code |
25000964
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$75.85 |
| Rate for Payer: Aetna Commercial |
$60.84
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.63
|
| Rate for Payer: Cash Price |
$39.51
|
| Rate for Payer: Cigna Commercial |
$65.58
|
| Rate for Payer: First Health Commercial |
$75.06
|
| Rate for Payer: Humana Commercial |
$67.16
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Kentucky WC Medicaid |
$27.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.53
|
| Rate for Payer: Ohio Health Group HMO |
$59.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.52
|
| Rate for Payer: PHCS Commercial |
$75.85
|
| Rate for Payer: United Healthcare All Payer |
$69.53
|
|
|
MESTINON TMSP 180 MG TABLET
|
Facility
|
IP
|
$79.01
|
|
|
Service Code
|
NDC 187301330
|
| Hospital Charge Code |
25000964
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$75.85 |
| Rate for Payer: Aetna Commercial |
$60.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.63
|
| Rate for Payer: Cash Price |
$39.51
|
| Rate for Payer: Cigna Commercial |
$65.58
|
| Rate for Payer: First Health Commercial |
$75.06
|
| Rate for Payer: Humana Commercial |
$67.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.53
|
| Rate for Payer: Ohio Health Group HMO |
$59.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.52
|
| Rate for Payer: PHCS Commercial |
$75.85
|
| Rate for Payer: United Healthcare All Payer |
$69.53
|
|
|
METACROSS OTW 10*20*135
|
Facility
|
OP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem Medicaid |
$596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Humana KY Medicaid |
$596.05
|
| Rate for Payer: Kentucky WC Medicaid |
$602.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 10*20*135
|
Facility
|
IP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 10*40*135
|
Facility
|
OP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem Medicaid |
$596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Humana KY Medicaid |
$596.05
|
| Rate for Payer: Kentucky WC Medicaid |
$602.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 10*40*135
|
Facility
|
IP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 10*60*135
|
Facility
|
IP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 10*60*135
|
Facility
|
OP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem Medicaid |
$596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Humana KY Medicaid |
$596.05
|
| Rate for Payer: Kentucky WC Medicaid |
$602.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 10*80*135
|
Facility
|
IP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 10*80*135
|
Facility
|
OP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem Medicaid |
$596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Humana KY Medicaid |
$596.05
|
| Rate for Payer: Kentucky WC Medicaid |
$602.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 12*20*135
|
Facility
|
OP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem Medicaid |
$596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Humana KY Medicaid |
$596.05
|
| Rate for Payer: Kentucky WC Medicaid |
$602.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 12*20*135
|
Facility
|
IP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 12*40*135
|
Facility
|
IP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 12*40*135
|
Facility
|
OP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem Medicaid |
$596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Humana KY Medicaid |
$596.05
|
| Rate for Payer: Kentucky WC Medicaid |
$602.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 4*100*135
|
Facility
|
OP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem Medicaid |
$596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Humana KY Medicaid |
$596.05
|
| Rate for Payer: Kentucky WC Medicaid |
$602.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 4*100*135
|
Facility
|
IP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
