|
METALBACK LG
|
Facility
|
OP
|
$9,059.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.77 |
| Max. Negotiated Rate |
$8,697.36 |
| Rate for Payer: Aetna Commercial |
$6,976.01
|
| Rate for Payer: Anthem Medicaid |
$3,115.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,066.60
|
| Rate for Payer: Cash Price |
$4,529.88
|
| Rate for Payer: Cigna Commercial |
$7,519.59
|
| Rate for Payer: First Health Commercial |
$8,606.76
|
| Rate for Payer: Humana Commercial |
$7,700.79
|
| Rate for Payer: Humana KY Medicaid |
$3,115.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,147.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,429.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,686.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,717.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,178.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,972.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,794.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,811.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,177.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,808.52
|
| Rate for Payer: PHCS Commercial |
$8,697.36
|
| Rate for Payer: United Healthcare All Payer |
$7,972.58
|
|
|
METALBACK LG
|
Facility
|
IP
|
$9,059.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.77 |
| Max. Negotiated Rate |
$8,697.36 |
| Rate for Payer: Aetna Commercial |
$6,976.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,066.60
|
| Rate for Payer: Cash Price |
$4,529.88
|
| Rate for Payer: Cigna Commercial |
$7,519.59
|
| Rate for Payer: First Health Commercial |
$8,606.76
|
| Rate for Payer: Humana Commercial |
$7,700.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,429.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,686.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,717.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,972.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,794.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,811.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,177.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,808.52
|
| Rate for Payer: PHCS Commercial |
$8,697.36
|
| Rate for Payer: United Healthcare All Payer |
$7,972.58
|
|
|
METALBACK MD
|
Facility
|
IP
|
$9,059.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.77 |
| Max. Negotiated Rate |
$8,697.36 |
| Rate for Payer: Aetna Commercial |
$6,976.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,066.60
|
| Rate for Payer: Cash Price |
$4,529.88
|
| Rate for Payer: Cigna Commercial |
$7,519.59
|
| Rate for Payer: First Health Commercial |
$8,606.76
|
| Rate for Payer: Humana Commercial |
$7,700.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,429.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,686.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,717.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,972.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,794.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,811.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,177.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,808.52
|
| Rate for Payer: PHCS Commercial |
$8,697.36
|
| Rate for Payer: United Healthcare All Payer |
$7,972.58
|
|
|
METALBACK MD
|
Facility
|
OP
|
$9,059.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.77 |
| Max. Negotiated Rate |
$8,697.36 |
| Rate for Payer: Aetna Commercial |
$6,976.01
|
| Rate for Payer: Anthem Medicaid |
$3,115.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,066.60
|
| Rate for Payer: Cash Price |
$4,529.88
|
| Rate for Payer: Cigna Commercial |
$7,519.59
|
| Rate for Payer: First Health Commercial |
$8,606.76
|
| Rate for Payer: Humana Commercial |
$7,700.79
|
| Rate for Payer: Humana KY Medicaid |
$3,115.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,147.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,429.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,686.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,717.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,178.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,972.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,794.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,811.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,177.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,808.52
|
| Rate for Payer: PHCS Commercial |
$8,697.36
|
| Rate for Payer: United Healthcare All Payer |
$7,972.58
|
|
|
METALBACK SM
|
Facility
|
IP
|
$9,059.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.77 |
| Max. Negotiated Rate |
$8,697.36 |
| Rate for Payer: Aetna Commercial |
$6,976.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,066.60
|
| Rate for Payer: Cash Price |
$4,529.88
|
| Rate for Payer: Cigna Commercial |
$7,519.59
|
| Rate for Payer: First Health Commercial |
$8,606.76
|
| Rate for Payer: Humana Commercial |
$7,700.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,429.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,686.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,717.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,972.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,794.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,811.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,177.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,808.52
|
| Rate for Payer: PHCS Commercial |
$8,697.36
|
| Rate for Payer: United Healthcare All Payer |
$7,972.58
|
|
|
METALBACK SM
|
Facility
|
OP
|
$9,059.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.77 |
| Max. Negotiated Rate |
$8,697.36 |
| Rate for Payer: Aetna Commercial |
$6,976.01
|
| Rate for Payer: Anthem Medicaid |
$3,115.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,066.60
|
| Rate for Payer: Cash Price |
$4,529.88
|
| Rate for Payer: Cigna Commercial |
$7,519.59
|
| Rate for Payer: First Health Commercial |
$8,606.76
|
| Rate for Payer: Humana Commercial |
$7,700.79
|
| Rate for Payer: Humana KY Medicaid |
$3,115.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,147.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,429.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,686.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,717.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,178.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,972.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,794.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,811.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,177.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,808.52
|
| Rate for Payer: PHCS Commercial |
$8,697.36
|
| Rate for Payer: United Healthcare All Payer |
$7,972.58
|
|
|
METAL ON METAL FEM HEAD 36M +5
|
Facility
|
IP
|
$11,585.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.12 |
| Max. Negotiated Rate |
$11,122.08 |
| Rate for Payer: Aetna Commercial |
$8,920.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,036.69
|
| Rate for Payer: Cash Price |
$5,792.75
|
| Rate for Payer: Cigna Commercial |
$9,615.96
|
| Rate for Payer: First Health Commercial |
$11,006.22
|
| Rate for Payer: Humana Commercial |
$9,847.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,500.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,550.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,475.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,195.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,689.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,317.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,506.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,591.50
|
| Rate for Payer: PHCS Commercial |
$11,122.08
|
| Rate for Payer: United Healthcare All Payer |
$10,195.24
|
|
|
METAL ON METAL FEM HEAD 36M +5
|
Facility
|
OP
|
$11,585.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.12 |
| Max. Negotiated Rate |
$11,122.08 |
| Rate for Payer: Aetna Commercial |
$8,920.84
|
| Rate for Payer: Anthem Medicaid |
$3,984.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,036.69
|
| Rate for Payer: Cash Price |
$5,792.75
|
| Rate for Payer: Cigna Commercial |
$9,615.96
|
| Rate for Payer: First Health Commercial |
$11,006.22
|
| Rate for Payer: Humana Commercial |
$9,847.68
|
| Rate for Payer: Humana KY Medicaid |
$3,984.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,500.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,550.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,475.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,064.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,195.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,689.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,317.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,506.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,591.50
|
| Rate for Payer: PHCS Commercial |
$11,122.08
|
| Rate for Payer: United Healthcare All Payer |
$10,195.24
|
|
|
METAL ON METL FEM HEAD 36M +11
|
Facility
|
OP
|
$11,267.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.81 |
| Max. Negotiated Rate |
$10,817.06 |
| Rate for Payer: Aetna Commercial |
$8,676.18
|
| Rate for Payer: Anthem Medicaid |
$3,874.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,788.86
|
| Rate for Payer: Cash Price |
$5,633.88
|
| Rate for Payer: Cigna Commercial |
$9,352.25
|
| Rate for Payer: First Health Commercial |
$10,704.38
|
| Rate for Payer: Humana Commercial |
$9,577.60
|
| Rate for Payer: Humana KY Medicaid |
$3,874.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,914.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,239.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,315.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,380.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,952.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,915.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,450.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,253.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,493.01
|
| Rate for Payer: PHCS Commercial |
$10,817.06
|
| Rate for Payer: United Healthcare All Payer |
$9,915.64
|
|
|
METAL ON METL FEM HEAD 36M +11
|
Facility
|
IP
|
$11,267.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.81 |
| Max. Negotiated Rate |
$10,817.06 |
| Rate for Payer: Aetna Commercial |
$8,676.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,788.86
|
| Rate for Payer: Cash Price |
$5,633.88
|
| Rate for Payer: Cigna Commercial |
$9,352.25
|
| Rate for Payer: First Health Commercial |
$10,704.38
|
| Rate for Payer: Humana Commercial |
$9,577.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,239.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,315.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,380.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,915.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,450.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,253.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,493.01
|
| Rate for Payer: PHCS Commercial |
$10,817.06
|
| Rate for Payer: United Healthcare All Payer |
$9,915.64
|
|
|
METAMUCIL (PSYLLIUM) EFFER 1EA
|
Facility
|
OP
|
$4.57
|
|
|
Service Code
|
NDC 37000002404
|
| Hospital Charge Code |
25000966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem Medicaid |
$1.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Humana KY Medicaid |
$1.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
METAMUCIL (PSYLLIUM) EFFER 1EA
|
Facility
|
IP
|
$4.57
|
|
|
Service Code
|
NDC 37000002404
|
| Hospital Charge Code |
25000966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
METANX TABLET
|
Facility
|
IP
|
$11.14
|
|
|
Service Code
|
NDC 525804990
|
| Hospital Charge Code |
25000967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$10.69 |
| Rate for Payer: Aetna Commercial |
$8.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.69
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Cigna Commercial |
$9.25
|
| Rate for Payer: First Health Commercial |
$10.58
|
| Rate for Payer: Humana Commercial |
$9.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.80
|
| Rate for Payer: Ohio Health Group HMO |
$8.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.45
|
| Rate for Payer: PHCS Commercial |
$10.69
|
| Rate for Payer: United Healthcare All Payer |
$9.80
|
|
|
METANX TABLET
|
Facility
|
OP
|
$11.14
|
|
|
Service Code
|
NDC 525804990
|
| Hospital Charge Code |
25000967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$10.69 |
| Rate for Payer: Aetna Commercial |
$8.58
|
| Rate for Payer: Anthem Medicaid |
$3.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.69
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Cigna Commercial |
$9.25
|
| Rate for Payer: First Health Commercial |
$10.58
|
| Rate for Payer: Humana Commercial |
$9.47
|
| Rate for Payer: Humana KY Medicaid |
$3.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.80
|
| Rate for Payer: Ohio Health Group HMO |
$8.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.45
|
| Rate for Payer: PHCS Commercial |
$10.69
|
| Rate for Payer: United Healthcare All Payer |
$9.80
|
|
|
METATARSAL DECOMPRESS IMP SZ 1
|
Facility
|
OP
|
$13,447.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.11 |
| Max. Negotiated Rate |
$12,909.12 |
| Rate for Payer: Aetna Commercial |
$10,354.19
|
| Rate for Payer: Anthem Medicaid |
$4,624.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,488.66
|
| Rate for Payer: Cash Price |
$6,723.50
|
| Rate for Payer: Cigna Commercial |
$11,161.01
|
| Rate for Payer: First Health Commercial |
$12,774.65
|
| Rate for Payer: Humana Commercial |
$11,429.95
|
| Rate for Payer: Humana KY Medicaid |
$4,624.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,671.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,026.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,923.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,034.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,717.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,833.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,085.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,689.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,748.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,168.57
|
| Rate for Payer: PHCS Commercial |
$12,909.12
|
| Rate for Payer: United Healthcare All Payer |
$11,833.36
|
|
|
METATARSAL DECOMPRESS IMP SZ 1
|
Facility
|
IP
|
$13,447.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.11 |
| Max. Negotiated Rate |
$12,909.12 |
| Rate for Payer: Aetna Commercial |
$10,354.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,488.66
|
| Rate for Payer: Cash Price |
$6,723.50
|
| Rate for Payer: Cigna Commercial |
$11,161.01
|
| Rate for Payer: First Health Commercial |
$12,774.65
|
| Rate for Payer: Humana Commercial |
$11,429.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,026.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,923.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,034.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,833.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,085.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,689.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,748.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,168.57
|
| Rate for Payer: PHCS Commercial |
$12,909.12
|
| Rate for Payer: United Healthcare All Payer |
$11,833.36
|
|
|
METATARSAL DECOMPRESS IMP SZ 2
|
Facility
|
IP
|
$13,447.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.11 |
| Max. Negotiated Rate |
$12,909.12 |
| Rate for Payer: Aetna Commercial |
$10,354.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,488.66
|
| Rate for Payer: Cash Price |
$6,723.50
|
| Rate for Payer: Cigna Commercial |
$11,161.01
|
| Rate for Payer: First Health Commercial |
$12,774.65
|
| Rate for Payer: Humana Commercial |
$11,429.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,026.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,923.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,034.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,833.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,085.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,689.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,748.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,168.57
|
| Rate for Payer: PHCS Commercial |
$12,909.12
|
| Rate for Payer: United Healthcare All Payer |
$11,833.36
|
|
|
METATARSAL DECOMPRESS IMP SZ 2
|
Facility
|
OP
|
$13,447.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.11 |
| Max. Negotiated Rate |
$12,909.12 |
| Rate for Payer: Aetna Commercial |
$10,354.19
|
| Rate for Payer: Anthem Medicaid |
$4,624.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,488.66
|
| Rate for Payer: Cash Price |
$6,723.50
|
| Rate for Payer: Cigna Commercial |
$11,161.01
|
| Rate for Payer: First Health Commercial |
$12,774.65
|
| Rate for Payer: Humana Commercial |
$11,429.95
|
| Rate for Payer: Humana KY Medicaid |
$4,624.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,671.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,026.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,923.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,034.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,717.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,833.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,085.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,689.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,748.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,168.57
|
| Rate for Payer: PHCS Commercial |
$12,909.12
|
| Rate for Payer: United Healthcare All Payer |
$11,833.36
|
|
|
METATARSAL DECOMPRESS IMP SZ 3
|
Facility
|
OP
|
$13,447.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.11 |
| Max. Negotiated Rate |
$12,909.12 |
| Rate for Payer: Aetna Commercial |
$10,354.19
|
| Rate for Payer: Anthem Medicaid |
$4,624.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,488.66
|
| Rate for Payer: Cash Price |
$6,723.50
|
| Rate for Payer: Cigna Commercial |
$11,161.01
|
| Rate for Payer: First Health Commercial |
$12,774.65
|
| Rate for Payer: Humana Commercial |
$11,429.95
|
| Rate for Payer: Humana KY Medicaid |
$4,624.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,671.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,026.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,923.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,034.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,717.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,833.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,085.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,689.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,748.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,168.57
|
| Rate for Payer: PHCS Commercial |
$12,909.12
|
| Rate for Payer: United Healthcare All Payer |
$11,833.36
|
|
|
METATARSAL DECOMPRESS IMP SZ 3
|
Facility
|
IP
|
$13,447.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.11 |
| Max. Negotiated Rate |
$12,909.12 |
| Rate for Payer: Aetna Commercial |
$10,354.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,488.66
|
| Rate for Payer: Cash Price |
$6,723.50
|
| Rate for Payer: Cigna Commercial |
$11,161.01
|
| Rate for Payer: First Health Commercial |
$12,774.65
|
| Rate for Payer: Humana Commercial |
$11,429.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,026.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,923.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,034.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,833.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,085.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,689.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,748.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,168.57
|
| Rate for Payer: PHCS Commercial |
$12,909.12
|
| Rate for Payer: United Healthcare All Payer |
$11,833.36
|
|
|
METATARSAL DECOMPRESS IMP SZ 4
|
Facility
|
IP
|
$13,447.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.11 |
| Max. Negotiated Rate |
$12,909.12 |
| Rate for Payer: Aetna Commercial |
$10,354.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,488.66
|
| Rate for Payer: Cash Price |
$6,723.50
|
| Rate for Payer: Cigna Commercial |
$11,161.01
|
| Rate for Payer: First Health Commercial |
$12,774.65
|
| Rate for Payer: Humana Commercial |
$11,429.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,026.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,923.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,034.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,833.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,085.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,689.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,748.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,168.57
|
| Rate for Payer: PHCS Commercial |
$12,909.12
|
| Rate for Payer: United Healthcare All Payer |
$11,833.36
|
|
|
METATARSAL DECOMPRESS IMP SZ 4
|
Facility
|
OP
|
$13,447.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.11 |
| Max. Negotiated Rate |
$12,909.12 |
| Rate for Payer: Aetna Commercial |
$10,354.19
|
| Rate for Payer: Anthem Medicaid |
$4,624.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,488.66
|
| Rate for Payer: Cash Price |
$6,723.50
|
| Rate for Payer: Cigna Commercial |
$11,161.01
|
| Rate for Payer: First Health Commercial |
$12,774.65
|
| Rate for Payer: Humana Commercial |
$11,429.95
|
| Rate for Payer: Humana KY Medicaid |
$4,624.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,671.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,026.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,923.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,034.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,717.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,833.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,085.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,689.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,748.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,168.57
|
| Rate for Payer: PHCS Commercial |
$12,909.12
|
| Rate for Payer: United Healthcare All Payer |
$11,833.36
|
|
|
METATARSECTOMY
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 28140
|
| Hospital Charge Code |
76100988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
METATARSECTOMY
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 28140
|
| Hospital Charge Code |
76100988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
METATARSECTOMY
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 28140
|
| Hospital Charge Code |
76100988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.41 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$700.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$219.41
|
| Rate for Payer: Anthem Medicaid |
$336.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$768.74
|
| Rate for Payer: Healthspan PPO |
$793.90
|
| Rate for Payer: Humana Medicaid |
$336.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$562.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$343.29
|
| Rate for Payer: Molina Healthcare Passport |
$336.56
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$230.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.93
|
|
