|
CRITICAL CARE ADDL 30MIN
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
51000167
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$907.20 |
| Rate for Payer: Aetna Commercial |
$727.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.10
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$784.35
|
| Rate for Payer: First Health Commercial |
$897.75
|
| Rate for Payer: Humana Commercial |
$803.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$831.60
|
| Rate for Payer: Ohio Health Group HMO |
$708.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.95
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
|
CRITICAL CARE ADDL 30MIN
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
51000167
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna Commercial |
$222.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.03
|
| Rate for Payer: Anthem Medicaid |
$88.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$945.00
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$160.23
|
| Rate for Payer: Healthspan PPO |
$135.01
|
| Rate for Payer: Humana Medicaid |
$88.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.51
|
| Rate for Payer: Molina Healthcare Passport |
$88.74
|
| Rate for Payer: Multiplan PHCS |
$567.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$661.50
|
| Rate for Payer: UHCCP Medicaid |
$57.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.63
|
|
|
CRITICAL CARE ADDL 30MIN
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
51000167
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$907.20 |
| Rate for Payer: Aetna Commercial |
$727.65
|
| Rate for Payer: Anthem Medicaid |
$324.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.10
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$784.35
|
| Rate for Payer: First Health Commercial |
$897.75
|
| Rate for Payer: Humana Commercial |
$803.25
|
| Rate for Payer: Humana KY Medicaid |
$324.99
|
| Rate for Payer: Kentucky WC Medicaid |
$328.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$331.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$831.60
|
| Rate for Payer: Ohio Health Group HMO |
$708.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.95
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
|
CRITICAL CARE FIRST HOUR
|
Professional
|
Both
|
$1,101.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
51000166
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.53 |
| Max. Negotiated Rate |
$1,101.00 |
| Rate for Payer: Aetna Commercial |
$443.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$109.53
|
| Rate for Payer: Anthem Medicaid |
$157.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,101.00
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cigna Commercial |
$319.95
|
| Rate for Payer: Healthspan PPO |
$296.94
|
| Rate for Payer: Humana Medicaid |
$157.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$298.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.83
|
| Rate for Payer: Molina Healthcare Passport |
$157.68
|
| Rate for Payer: Multiplan PHCS |
$660.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.70
|
| Rate for Payer: UHCCP Medicaid |
$115.01
|
| Rate for Payer: United Healthcare Non-Options |
$232.35
|
| Rate for Payer: United Healthcare Options |
$190.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.26
|
|
|
CRITICAL CARE FIRST HOUR
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
51000166
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$143.13 |
| Max. Negotiated Rate |
$1,074.30 |
| Rate for Payer: Aetna Commercial |
$847.77
|
| Rate for Payer: Anthem Medicaid |
$378.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$767.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,074.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,035.94
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cigna Commercial |
$913.83
|
| Rate for Payer: First Health Commercial |
$1,045.95
|
| Rate for Payer: Humana Commercial |
$935.85
|
| Rate for Payer: Humana KY Medicaid |
$378.63
|
| Rate for Payer: Humana Medicare Advantage |
$767.36
|
| Rate for Payer: Kentucky WC Medicaid |
$382.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$812.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$386.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.88
|
| Rate for Payer: Ohio Health Group HMO |
$825.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.31
|
| Rate for Payer: PHCS Commercial |
$1,056.96
|
| Rate for Payer: United Healthcare All Payer |
$968.88
|
|
|
CRITICAL CARE FIRST HOUR
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
51000166
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$143.13 |
| Max. Negotiated Rate |
$1,056.96 |
| Rate for Payer: Aetna Commercial |
$847.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.78
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cigna Commercial |
$913.83
|
| Rate for Payer: First Health Commercial |
$1,045.95
|
| Rate for Payer: Humana Commercial |
$935.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$812.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.88
|
| Rate for Payer: Ohio Health Group HMO |
$825.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.31
|
| Rate for Payer: PHCS Commercial |
$1,056.96
|
| Rate for Payer: United Healthcare All Payer |
$968.88
|
|
|
CRITICAL CARE FIRST HOUR
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
45000006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.40 |
| Max. Negotiated Rate |
$1,132.80 |
| Rate for Payer: Aetna Commercial |
$908.60
|
| Rate for Payer: Anthem Medicaid |
$405.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$767.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$920.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,074.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,035.94
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$979.40
|
| Rate for Payer: First Health Commercial |
$1,121.00
|
| Rate for Payer: Humana Commercial |
$1,003.00
|
| Rate for Payer: Humana KY Medicaid |
$405.80
|
| Rate for Payer: Humana Medicare Advantage |
$767.36
|
| Rate for Payer: Kentucky WC Medicaid |
$409.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$967.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$870.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$413.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,038.40
|
| Rate for Payer: Ohio Health Group HMO |
$885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.80
|
| Rate for Payer: PHCS Commercial |
$1,132.80
|
| Rate for Payer: United Healthcare All Payer |
$1,038.40
|
|
|
CRITICAL CARE FIRST HOUR
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
45000006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.40 |
| Max. Negotiated Rate |
$1,132.80 |
| Rate for Payer: Aetna Commercial |
$908.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$920.40
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$979.40
|
| Rate for Payer: First Health Commercial |
$1,121.00
|
| Rate for Payer: Humana Commercial |
$1,003.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$967.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$870.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,038.40
|
| Rate for Payer: Ohio Health Group HMO |
$885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.80
|
| Rate for Payer: PHCS Commercial |
$1,132.80
|
| Rate for Payer: United Healthcare All Payer |
$1,038.40
|
|
|
[C]ROBITUSSIN AC(GUAIF/CO 10ML
|
Facility
|
OP
|
$60.33
|
|
|
Service Code
|
NDC 121077516
|
| Hospital Charge Code |
25000119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$57.92 |
| Rate for Payer: Aetna Commercial |
$46.45
|
| Rate for Payer: Anthem Medicaid |
$20.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.06
|
| Rate for Payer: Cash Price |
$30.16
|
| Rate for Payer: Cigna Commercial |
$50.07
|
| Rate for Payer: First Health Commercial |
$57.31
|
| Rate for Payer: Humana Commercial |
$51.28
|
| Rate for Payer: Humana KY Medicaid |
$20.75
|
| Rate for Payer: Kentucky WC Medicaid |
$20.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.09
|
| Rate for Payer: Ohio Health Group HMO |
$45.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.70
|
| Rate for Payer: PHCS Commercial |
$57.92
|
| Rate for Payer: United Healthcare All Payer |
$53.09
|
|
|
[C]ROBITUSSIN AC(GUAIF/CO 10ML
|
Facility
|
IP
|
$60.33
|
|
|
Service Code
|
NDC 121077516
|
| Hospital Charge Code |
25000119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$57.92 |
| Rate for Payer: Aetna Commercial |
$46.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.06
|
| Rate for Payer: Cash Price |
$30.16
|
| Rate for Payer: Cigna Commercial |
$50.07
|
| Rate for Payer: First Health Commercial |
$57.31
|
| Rate for Payer: Humana Commercial |
$51.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.09
|
| Rate for Payer: Ohio Health Group HMO |
$45.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.70
|
| Rate for Payer: PHCS Commercial |
$57.92
|
| Rate for Payer: United Healthcare All Payer |
$53.09
|
|
|
CROFAB CROT POLYFAB >1GRM (VL)
|
Facility
|
IP
|
$17,429.10
|
|
|
Service Code
|
HCPCS J0840
|
| Hospital Charge Code |
25001971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,265.78 |
| Max. Negotiated Rate |
$16,731.94 |
| Rate for Payer: Humana Commercial |
$14,814.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,291.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,862.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,228.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,337.61
|
| Rate for Payer: Ohio Health Group HMO |
$13,071.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,485.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,265.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,403.02
|
| Rate for Payer: PHCS Commercial |
$16,731.94
|
| Rate for Payer: United Healthcare All Payer |
$15,337.61
|
| Rate for Payer: Aetna Commercial |
$13,420.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,594.70
|
| Rate for Payer: Cash Price |
$8,714.55
|
| Rate for Payer: Cigna Commercial |
$14,466.15
|
| Rate for Payer: First Health Commercial |
$16,557.64
|
|
|
CROFAB CROT POLYFAB >1GRM (VL)
|
Facility
|
OP
|
$17,429.10
|
|
|
Service Code
|
HCPCS J0840
|
| Hospital Charge Code |
25001971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,949.92 |
| Max. Negotiated Rate |
$16,731.94 |
| Rate for Payer: Aetna Commercial |
$13,420.41
|
| Rate for Payer: Anthem Medicaid |
$5,993.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,949.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,594.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,729.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,632.39
|
| Rate for Payer: Cash Price |
$8,714.55
|
| Rate for Payer: Cash Price |
$8,714.55
|
| Rate for Payer: Cigna Commercial |
$14,466.15
|
| Rate for Payer: First Health Commercial |
$16,557.64
|
| Rate for Payer: Humana Commercial |
$14,814.74
|
| Rate for Payer: Humana KY Medicaid |
$5,993.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,949.92
|
| Rate for Payer: Kentucky WC Medicaid |
$6,054.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,291.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,862.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,339.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,114.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,337.61
|
| Rate for Payer: Ohio Health Group HMO |
$13,071.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,485.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,265.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,403.02
|
| Rate for Payer: PHCS Commercial |
$16,731.94
|
| Rate for Payer: United Healthcare All Payer |
$15,337.61
|
|
|
CROSPERIO OTW 1.5*120*150
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
|
|
CROSPERIO OTW 1.5*120*150
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 1.5*20*150
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 1.5*20*150
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 1.5*40*150
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 1.5*40*150
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 1.5*80*150
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CROSPERIO OTW 1.5*80*150
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CROSPERIO OTW 2*120*150
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 2*120*150
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
|
|
CROSPERIO OTW 2*150*150
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 2*150*150
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 2*200*150
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
