|
METACROSS OTW 4*120*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*120*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 4*150*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 4*150*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*200*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*200*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 4*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 4*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 4*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*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 4*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 4*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 4*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 4*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 5*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
|
|
|
METACROSS OTW 5*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 5*120*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 5*120*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 5*150*135
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
METACROSS OTW 5*200*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 5*200*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 5*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 5*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 5*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
|
|
