|
NANOCROS.014 OTWPTA 2.5*150*15
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROS.014 OTWPTA 2.5*210*15
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
NANOCROS.014 OTWPTA 2.5*210*15
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
NANOCROS.014 OTWPTA 2.5*80*150
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROS.014 OTWPTA 2.5*80*150
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROS .014 OTW PTA 2*80*150
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
NANOCROS .014 OTW PTA 2*80*150
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
NANOCROS 014 OTW PTA 3*100*150
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROS 014 OTW PTA 3*100*150
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROS .014 OTWPTA 3*150*150
|
Facility
|
OP
|
$3,612.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,083.75 |
| Max. Negotiated Rate |
$3,468.00 |
| Rate for Payer: Aetna Commercial |
$2,781.62
|
| Rate for Payer: Anthem Medicaid |
$1,242.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,817.75
|
| Rate for Payer: Cash Price |
$1,806.25
|
| Rate for Payer: Cigna Commercial |
$2,998.38
|
| Rate for Payer: First Health Commercial |
$3,431.88
|
| Rate for Payer: Humana Commercial |
$3,070.62
|
| Rate for Payer: Humana KY Medicaid |
$1,242.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,254.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,962.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,666.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,267.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,179.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,709.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,890.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,142.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,492.62
|
| Rate for Payer: PHCS Commercial |
$3,468.00
|
| Rate for Payer: United Healthcare All Payer |
$3,179.00
|
|
|
NANOCROS .014 OTWPTA 3*150*150
|
Facility
|
IP
|
$3,612.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,083.75 |
| Max. Negotiated Rate |
$3,468.00 |
| Rate for Payer: Aetna Commercial |
$2,781.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,817.75
|
| Rate for Payer: Cash Price |
$1,806.25
|
| Rate for Payer: Cigna Commercial |
$2,998.38
|
| Rate for Payer: First Health Commercial |
$3,431.88
|
| Rate for Payer: Humana Commercial |
$3,070.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,962.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,666.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,179.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,709.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,890.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,142.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,492.62
|
| Rate for Payer: PHCS Commercial |
$3,468.00
|
| Rate for Payer: United Healthcare All Payer |
$3,179.00
|
|
|
NANOCROS .014 OTWPTA 3*210*150
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
NANOCROS .014 OTWPTA 3*210*150
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
NANOCROS .014 OTW PTA 3*80*150
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
NANOCROS .014 OTW PTA 3*80*150
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
NANOCROS .014 OTWPTA 4*150*150
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
NANOCROS .014 OTWPTA 4*150*150
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
NANOCROS .014 OTWPTA 4*210*150
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROS .014 OTWPTA 4*210*150
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROS .014 OTW PTA 4*80*150
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
NANOCROS .014 OTW PTA 4*80*150
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
NANOCROSS ELITE 5*100
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROSS ELITE 5*100
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROSS ELITE 5*200
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROSS ELITE 5*200
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
