|
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 |
$567.00 |
| Rate for Payer: Aetna Commercial |
$222.07
|
| Rate for Payer: Ambetter Exchange |
$101.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.03
|
| Rate for Payer: Anthem Medicaid |
$96.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.21
|
| 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 |
$96.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.69
|
| Rate for Payer: Molina Healthcare Passport |
$96.75
|
| Rate for Payer: Multiplan PHCS |
$567.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.31
|
| Rate for Payer: UHCCP Medicaid |
$57.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.01
|
|
|
CRITICAL CARE ADDL 30MIN
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
51000167
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$283.50 |
| 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 |
$756.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$822.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$652.05
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
|
CRITICAL CARE ADDL 30MIN (P
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
510P0167
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna Commercial |
$222.07
|
| Rate for Payer: Ambetter Exchange |
$101.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.03
|
| Rate for Payer: Anthem Medicaid |
$96.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.21
|
| 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 |
$96.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.69
|
| Rate for Payer: Molina Healthcare Passport |
$96.75
|
| Rate for Payer: Multiplan PHCS |
$567.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.31
|
| Rate for Payer: UHCCP Medicaid |
$57.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.01
|
|
|
CRITICAL CARE FIRST HOUR
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
45000006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$431.94 |
| Max. Negotiated Rate |
$1,205.76 |
| Rate for Payer: Aetna Commercial |
$967.12
|
| Rate for Payer: Anthem Medicaid |
$431.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$778.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$979.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,089.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,051.04
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cigna Commercial |
$1,042.48
|
| Rate for Payer: First Health Commercial |
$1,193.20
|
| Rate for Payer: Humana Commercial |
$1,067.60
|
| Rate for Payer: Humana KY Medicaid |
$431.94
|
| Rate for Payer: Humana Medicare Advantage |
$778.55
|
| Rate for Payer: Kentucky WC Medicaid |
$436.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,029.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$926.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$440.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,105.28
|
| Rate for Payer: Ohio Health Group HMO |
$942.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,092.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$866.64
|
| Rate for Payer: PHCS Commercial |
$1,205.76
|
| Rate for Payer: United Healthcare All Payer |
$1,105.28
|
|
|
CRITICAL CARE FIRST HOUR
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
45000006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$376.80 |
| Max. Negotiated Rate |
$1,205.76 |
| Rate for Payer: Aetna Commercial |
$967.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$979.68
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cigna Commercial |
$1,042.48
|
| Rate for Payer: First Health Commercial |
$1,193.20
|
| Rate for Payer: Humana Commercial |
$1,067.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,029.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$926.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$376.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,105.28
|
| Rate for Payer: Ohio Health Group HMO |
$942.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,092.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$866.64
|
| Rate for Payer: PHCS Commercial |
$1,205.76
|
| Rate for Payer: United Healthcare All Payer |
$1,105.28
|
|
|
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 |
$660.60 |
| Rate for Payer: Aetna Commercial |
$443.90
|
| Rate for Payer: Ambetter Exchange |
$202.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$109.53
|
| Rate for Payer: Anthem Medicaid |
$215.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$202.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.53
|
| 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 |
$215.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$298.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$202.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$219.32
|
| Rate for Payer: Molina Healthcare Passport |
$215.02
|
| Rate for Payer: Multiplan PHCS |
$660.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.74
|
| 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 |
$217.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.11
|
|
|
CRITICAL CARE FIRST HOUR (P
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
510P0166
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.53 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$443.90
|
| Rate for Payer: Ambetter Exchange |
$202.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$109.53
|
| Rate for Payer: Anthem Medicaid |
$215.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$202.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.53
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna Commercial |
$319.95
|
| Rate for Payer: Healthspan PPO |
$296.94
|
| Rate for Payer: Humana Medicaid |
$215.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$298.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$202.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$219.32
|
| Rate for Payer: Molina Healthcare Passport |
$215.02
|
| Rate for Payer: Multiplan PHCS |
$633.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.74
|
| 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 |
$217.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.11
|
|
|
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 |
$1,861.13 |
| 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 |
$1,861.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,594.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,605.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,512.53
|
| 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 |
$16,557.65
|
| Rate for Payer: Humana Commercial |
$14,814.74
|
| Rate for Payer: Humana KY Medicaid |
$5,993.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,861.13
|
| 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 |
$2,233.36
|
| 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 |
$13,071.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,943.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,163.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,026.08
|
| Rate for Payer: PHCS Commercial |
$16,731.94
|
| Rate for Payer: United Healthcare All Payer |
$15,337.61
|
|
|
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 |
$5,228.73 |
| Max. Negotiated Rate |
$16,731.94 |
| 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 |
$16,557.65
|
| 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 |
$13,071.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,943.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,163.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,026.08
|
| 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
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 1.5*120*150
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 1.5*20*150
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 1.5*20*150
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 1.5*40*150
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 1.5*40*150
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
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 |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
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 |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CROSPERIO OTW 2*120*150
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 2*120*150
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 2*150*150
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 2*150*150
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 2*200*150
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 2*200*150
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 2*40*150
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CROSPERIO OTW 2*40*150
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
