|
CROSSTELLA OTW 2.5*100*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*100*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*120*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*120*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*150*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
| Rate for Payer: Aetna Commercial |
$1,538.08
|
|
|
CROSSTELLA OTW 2.5*150*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*200*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*200*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*20*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*20*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*40*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*40*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*60*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*60*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*80*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2.5*80*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2*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
|
|
|
CROSSTELLA OTW 2*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
|
|
|
CROSSTELLA OTW 3*100*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
|
|
CROSSTELLA OTW 3*100*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 3*120*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 3*120*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 3*150*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 3*150*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 3*200*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
