|
METACROSS OTW 8*60*135
|
Facility
|
IP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 8*60*135
|
Facility
|
OP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem Medicaid |
$596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Humana KY Medicaid |
$596.05
|
| Rate for Payer: Kentucky WC Medicaid |
$602.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 8*80*135
|
Facility
|
IP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METACROSS OTW 8*80*135
|
Facility
|
OP
|
$1,733.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$1,663.87 |
| Rate for Payer: Aetna Commercial |
$1,334.56
|
| Rate for Payer: Anthem Medicaid |
$596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.90
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cigna Commercial |
$1,438.56
|
| Rate for Payer: First Health Commercial |
$1,646.54
|
| Rate for Payer: Humana Commercial |
$1,473.22
|
| Rate for Payer: Humana KY Medicaid |
$596.05
|
| Rate for Payer: Kentucky WC Medicaid |
$602.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,279.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,525.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.91
|
| Rate for Payer: PHCS Commercial |
$1,663.87
|
| Rate for Payer: United Healthcare All Payer |
$1,525.22
|
|
|
METAGLENE LONG PEG +10MM
|
Facility
|
OP
|
$17,079.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,123.97 |
| Max. Negotiated Rate |
$16,396.70 |
| Rate for Payer: Aetna Commercial |
$13,151.52
|
| Rate for Payer: Anthem Medicaid |
$5,873.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,322.32
|
| Rate for Payer: Cash Price |
$8,539.95
|
| Rate for Payer: Cigna Commercial |
$14,176.32
|
| Rate for Payer: First Health Commercial |
$16,225.91
|
| Rate for Payer: Humana Commercial |
$14,517.92
|
| Rate for Payer: Humana KY Medicaid |
$5,873.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,933.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,005.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,604.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,123.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,991.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,030.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,809.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,663.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,859.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,785.13
|
| Rate for Payer: PHCS Commercial |
$16,396.70
|
| Rate for Payer: United Healthcare All Payer |
$15,030.31
|
|
|
METAGLENE LONG PEG +10MM
|
Facility
|
IP
|
$17,079.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,123.97 |
| Max. Negotiated Rate |
$16,396.70 |
| Rate for Payer: Aetna Commercial |
$13,151.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,322.32
|
| Rate for Payer: Cash Price |
$8,539.95
|
| Rate for Payer: Cigna Commercial |
$14,176.32
|
| Rate for Payer: First Health Commercial |
$16,225.91
|
| Rate for Payer: Humana Commercial |
$14,517.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,005.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,604.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,123.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,030.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,809.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,663.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,859.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,785.13
|
| Rate for Payer: PHCS Commercial |
$16,396.70
|
| Rate for Payer: United Healthcare All Payer |
$15,030.31
|
|
|
METAGLENE LONG PEG +15MM
|
Facility
|
IP
|
$17,079.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,123.97 |
| Max. Negotiated Rate |
$16,396.70 |
| Rate for Payer: Aetna Commercial |
$13,151.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,322.32
|
| Rate for Payer: Cash Price |
$8,539.95
|
| Rate for Payer: Cigna Commercial |
$14,176.32
|
| Rate for Payer: First Health Commercial |
$16,225.91
|
| Rate for Payer: Humana Commercial |
$14,517.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,005.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,604.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,123.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,030.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,809.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,663.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,859.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,785.13
|
| Rate for Payer: PHCS Commercial |
$16,396.70
|
| Rate for Payer: United Healthcare All Payer |
$15,030.31
|
|
|
METAGLENE LONG PEG +15MM
|
Facility
|
OP
|
$17,079.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,123.97 |
| Max. Negotiated Rate |
$16,396.70 |
| Rate for Payer: Aetna Commercial |
$13,151.52
|
| Rate for Payer: Anthem Medicaid |
$5,873.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,322.32
|
| Rate for Payer: Cash Price |
$8,539.95
|
| Rate for Payer: Cigna Commercial |
$14,176.32
|
| Rate for Payer: First Health Commercial |
$16,225.91
|
| Rate for Payer: Humana Commercial |
$14,517.92
|
| Rate for Payer: Humana KY Medicaid |
$5,873.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,933.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,005.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,604.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,123.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,991.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,030.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,809.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,663.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,859.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,785.13
|
| Rate for Payer: PHCS Commercial |
$16,396.70
|
| Rate for Payer: United Healthcare All Payer |
$15,030.31
|
|
|
METAGLENE STANDARD V3.2
|
Facility
|
IP
|
$12,219.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,665.98 |
| Max. Negotiated Rate |
$11,731.12 |
| Rate for Payer: Aetna Commercial |
$9,409.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,531.54
|
| Rate for Payer: Cash Price |
$6,109.96
|
| Rate for Payer: Cigna Commercial |
$10,142.53
|
| Rate for Payer: First Health Commercial |
$11,608.92
|
| Rate for Payer: Humana Commercial |
$10,386.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,020.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,018.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,665.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,753.53
|
| Rate for Payer: Ohio Health Group HMO |
$9,164.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,775.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,631.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,431.74
|
| Rate for Payer: PHCS Commercial |
$11,731.12
|
| Rate for Payer: United Healthcare All Payer |
$10,753.53
|
|
|
METAGLENE STANDARD V3.2
|
Facility
|
OP
|
$12,219.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,665.98 |
| Max. Negotiated Rate |
$11,731.12 |
| Rate for Payer: Aetna Commercial |
$9,409.34
|
| Rate for Payer: Anthem Medicaid |
$4,202.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,531.54
|
| Rate for Payer: Cash Price |
$6,109.96
|
| Rate for Payer: Cigna Commercial |
$10,142.53
|
| Rate for Payer: First Health Commercial |
$11,608.92
|
| Rate for Payer: Humana Commercial |
$10,386.93
|
| Rate for Payer: Humana KY Medicaid |
$4,202.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,245.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,020.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,018.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,665.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,286.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,753.53
|
| Rate for Payer: Ohio Health Group HMO |
$9,164.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,775.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,631.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,431.74
|
| Rate for Payer: PHCS Commercial |
$11,731.12
|
| Rate for Payer: United Healthcare All Payer |
$10,753.53
|
|
|
METALBACK LG
|
Facility
|
OP
|
$9,259.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,777.93 |
| Max. Negotiated Rate |
$8,889.36 |
| Rate for Payer: Aetna Commercial |
$7,130.01
|
| Rate for Payer: Anthem Medicaid |
$3,184.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,222.60
|
| Rate for Payer: Cash Price |
$4,629.88
|
| Rate for Payer: Cigna Commercial |
$7,685.59
|
| Rate for Payer: First Health Commercial |
$8,796.76
|
| Rate for Payer: Humana Commercial |
$7,870.79
|
| Rate for Payer: Humana KY Medicaid |
$3,184.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,216.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,592.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,833.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,777.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,248.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,148.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,407.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,055.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,389.23
|
| Rate for Payer: PHCS Commercial |
$8,889.36
|
| Rate for Payer: United Healthcare All Payer |
$8,148.58
|
|
|
METALBACK LG
|
Facility
|
IP
|
$9,259.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,777.93 |
| Max. Negotiated Rate |
$8,889.36 |
| Rate for Payer: Aetna Commercial |
$7,130.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,222.60
|
| Rate for Payer: Cash Price |
$4,629.88
|
| Rate for Payer: Cigna Commercial |
$7,685.59
|
| Rate for Payer: First Health Commercial |
$8,796.76
|
| Rate for Payer: Humana Commercial |
$7,870.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,592.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,833.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,777.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,148.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,407.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,055.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,389.23
|
| Rate for Payer: PHCS Commercial |
$8,889.36
|
| Rate for Payer: United Healthcare All Payer |
$8,148.58
|
|
|
METALBACK MD
|
Facility
|
IP
|
$9,259.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,777.93 |
| Max. Negotiated Rate |
$8,889.36 |
| Rate for Payer: Aetna Commercial |
$7,130.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,222.60
|
| Rate for Payer: Cash Price |
$4,629.88
|
| Rate for Payer: Cigna Commercial |
$7,685.59
|
| Rate for Payer: First Health Commercial |
$8,796.76
|
| Rate for Payer: Humana Commercial |
$7,870.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,592.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,833.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,777.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,148.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,407.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,055.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,389.23
|
| Rate for Payer: PHCS Commercial |
$8,889.36
|
| Rate for Payer: United Healthcare All Payer |
$8,148.58
|
|
|
METALBACK MD
|
Facility
|
OP
|
$9,259.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,777.93 |
| Max. Negotiated Rate |
$8,889.36 |
| Rate for Payer: Aetna Commercial |
$7,130.01
|
| Rate for Payer: Anthem Medicaid |
$3,184.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,222.60
|
| Rate for Payer: Cash Price |
$4,629.88
|
| Rate for Payer: Cigna Commercial |
$7,685.59
|
| Rate for Payer: First Health Commercial |
$8,796.76
|
| Rate for Payer: Humana Commercial |
$7,870.79
|
| Rate for Payer: Humana KY Medicaid |
$3,184.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,216.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,592.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,833.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,777.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,248.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,148.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,407.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,055.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,389.23
|
| Rate for Payer: PHCS Commercial |
$8,889.36
|
| Rate for Payer: United Healthcare All Payer |
$8,148.58
|
|
|
METALBACK SM
|
Facility
|
IP
|
$9,259.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,777.93 |
| Max. Negotiated Rate |
$8,889.36 |
| Rate for Payer: Aetna Commercial |
$7,130.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,222.60
|
| Rate for Payer: Cash Price |
$4,629.88
|
| Rate for Payer: Cigna Commercial |
$7,685.59
|
| Rate for Payer: First Health Commercial |
$8,796.76
|
| Rate for Payer: Humana Commercial |
$7,870.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,592.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,833.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,777.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,148.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,407.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,055.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,389.23
|
| Rate for Payer: PHCS Commercial |
$8,889.36
|
| Rate for Payer: United Healthcare All Payer |
$8,148.58
|
|
|
METALBACK SM
|
Facility
|
OP
|
$9,259.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,777.93 |
| Max. Negotiated Rate |
$8,889.36 |
| Rate for Payer: Aetna Commercial |
$7,130.01
|
| Rate for Payer: Anthem Medicaid |
$3,184.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,222.60
|
| Rate for Payer: Cash Price |
$4,629.88
|
| Rate for Payer: Cigna Commercial |
$7,685.59
|
| Rate for Payer: First Health Commercial |
$8,796.76
|
| Rate for Payer: Humana Commercial |
$7,870.79
|
| Rate for Payer: Humana KY Medicaid |
$3,184.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,216.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,592.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,833.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,777.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,248.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,148.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,407.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,055.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,389.23
|
| Rate for Payer: PHCS Commercial |
$8,889.36
|
| Rate for Payer: United Healthcare All Payer |
$8,148.58
|
|
|
METAL ON METAL FEM HEAD 36M +5
|
Facility
|
OP
|
$11,830.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,549.27 |
| Max. Negotiated Rate |
$11,357.66 |
| Rate for Payer: Aetna Commercial |
$9,109.79
|
| Rate for Payer: Anthem Medicaid |
$4,068.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,228.10
|
| Rate for Payer: Cash Price |
$5,915.45
|
| Rate for Payer: Cigna Commercial |
$9,819.65
|
| Rate for Payer: First Health Commercial |
$11,239.35
|
| Rate for Payer: Humana Commercial |
$10,056.26
|
| Rate for Payer: Humana KY Medicaid |
$4,068.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,110.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,701.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,731.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,549.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,150.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,411.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,873.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,464.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,292.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,163.32
|
| Rate for Payer: PHCS Commercial |
$11,357.66
|
| Rate for Payer: United Healthcare All Payer |
$10,411.19
|
|
|
METAL ON METAL FEM HEAD 36M +5
|
Facility
|
IP
|
$11,830.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,549.27 |
| Max. Negotiated Rate |
$11,357.66 |
| Rate for Payer: Aetna Commercial |
$9,109.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,228.10
|
| Rate for Payer: Cash Price |
$5,915.45
|
| Rate for Payer: Cigna Commercial |
$9,819.65
|
| Rate for Payer: First Health Commercial |
$11,239.35
|
| Rate for Payer: Humana Commercial |
$10,056.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,701.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,731.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,549.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,411.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,873.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,464.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,292.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,163.32
|
| Rate for Payer: PHCS Commercial |
$11,357.66
|
| Rate for Payer: United Healthcare All Payer |
$10,411.19
|
|
|
METAL ON METL FEM HEAD 36M +11
|
Facility
|
IP
|
$11,511.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,453.43 |
| Max. Negotiated Rate |
$11,050.97 |
| Rate for Payer: Aetna Commercial |
$8,863.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,978.92
|
| Rate for Payer: Cash Price |
$5,755.71
|
| Rate for Payer: Cigna Commercial |
$9,554.49
|
| Rate for Payer: First Health Commercial |
$10,935.86
|
| Rate for Payer: Humana Commercial |
$9,784.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,439.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,495.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,130.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,633.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,209.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,014.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,942.89
|
| Rate for Payer: PHCS Commercial |
$11,050.97
|
| Rate for Payer: United Healthcare All Payer |
$10,130.06
|
|
|
METAL ON METL FEM HEAD 36M +11
|
Facility
|
OP
|
$11,511.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,453.43 |
| Max. Negotiated Rate |
$11,050.97 |
| Rate for Payer: Aetna Commercial |
$8,863.80
|
| Rate for Payer: Anthem Medicaid |
$3,958.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,978.92
|
| Rate for Payer: Cash Price |
$5,755.71
|
| Rate for Payer: Cigna Commercial |
$9,554.49
|
| Rate for Payer: First Health Commercial |
$10,935.86
|
| Rate for Payer: Humana Commercial |
$9,784.72
|
| Rate for Payer: Humana KY Medicaid |
$3,958.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,999.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,439.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,495.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,038.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,130.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,633.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,209.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,014.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,942.89
|
| Rate for Payer: PHCS Commercial |
$11,050.97
|
| Rate for Payer: United Healthcare All Payer |
$10,130.06
|
|
|
METAMUCIL (PSYLLIUM) EFFER 1EA
|
Facility
|
IP
|
$4.57
|
|
|
Service Code
|
NDC 37000002404
|
| Hospital Charge Code |
25000966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| 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 |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
METAMUCIL (PSYLLIUM) EFFER 1EA
|
Facility
|
OP
|
$4.57
|
|
|
Service Code
|
NDC 37000002404
|
| Hospital Charge Code |
25000966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| 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 |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
METANX TABLET
|
Facility
|
IP
|
$11.30
|
|
|
Service Code
|
NDC 525804990
|
| Hospital Charge Code |
25000967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$10.85 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.81
|
| Rate for Payer: Cash Price |
$5.65
|
| Rate for Payer: Cigna Commercial |
$9.38
|
| Rate for Payer: First Health Commercial |
$10.73
|
| Rate for Payer: Humana Commercial |
$9.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.94
|
| Rate for Payer: Ohio Health Group HMO |
$8.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.80
|
| Rate for Payer: PHCS Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Payer |
$9.94
|
|
|
METANX TABLET
|
Facility
|
OP
|
$11.30
|
|
|
Service Code
|
NDC 525804990
|
| Hospital Charge Code |
25000967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$10.85 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Anthem Medicaid |
$3.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.81
|
| Rate for Payer: Cash Price |
$5.65
|
| Rate for Payer: Cigna Commercial |
$9.38
|
| Rate for Payer: First Health Commercial |
$10.73
|
| Rate for Payer: Humana Commercial |
$9.61
|
| Rate for Payer: Humana KY Medicaid |
$3.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.94
|
| Rate for Payer: Ohio Health Group HMO |
$8.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.80
|
| Rate for Payer: PHCS Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Payer |
$9.94
|
|
|
METATARSAL DECOMPRESS IMP SZ 1
|
Facility
|
IP
|
$13,702.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,110.78 |
| Max. Negotiated Rate |
$13,154.50 |
| Rate for Payer: Aetna Commercial |
$10,551.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,688.03
|
| Rate for Payer: Cash Price |
$6,851.30
|
| Rate for Payer: Cigna Commercial |
$11,373.16
|
| Rate for Payer: First Health Commercial |
$13,017.47
|
| Rate for Payer: Humana Commercial |
$11,647.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,236.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,112.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,110.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,058.29
|
| Rate for Payer: Ohio Health Group HMO |
$10,276.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,962.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,921.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,454.79
|
| Rate for Payer: PHCS Commercial |
$13,154.50
|
| Rate for Payer: United Healthcare All Payer |
$12,058.29
|
|
