|
METATARSAL DECOMPRESS IMP SZ 1
|
Facility
|
OP
|
$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 Medicaid |
$4,712.32
|
| 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: Humana KY Medicaid |
$4,712.32
|
| Rate for Payer: Kentucky WC Medicaid |
$4,760.28
|
| 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: Molina Healthcare Medicaid |
$4,806.87
|
| 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
|
|
|
METATARSAL DECOMPRESS IMP SZ 2
|
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
|
|
|
METATARSAL DECOMPRESS IMP SZ 2
|
Facility
|
OP
|
$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 Medicaid |
$4,712.32
|
| 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: Humana KY Medicaid |
$4,712.32
|
| Rate for Payer: Kentucky WC Medicaid |
$4,760.28
|
| 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: Molina Healthcare Medicaid |
$4,806.87
|
| 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
|
|
|
METATARSAL DECOMPRESS IMP SZ 3
|
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
|
|
|
METATARSAL DECOMPRESS IMP SZ 3
|
Facility
|
OP
|
$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 Medicaid |
$4,712.32
|
| 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: Humana KY Medicaid |
$4,712.32
|
| Rate for Payer: Kentucky WC Medicaid |
$4,760.28
|
| 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: Molina Healthcare Medicaid |
$4,806.87
|
| 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
|
|
|
METATARSAL DECOMPRESS IMP SZ 4
|
Facility
|
OP
|
$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 Medicaid |
$4,712.32
|
| 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: Humana KY Medicaid |
$4,712.32
|
| Rate for Payer: Kentucky WC Medicaid |
$4,760.28
|
| 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: Molina Healthcare Medicaid |
$4,806.87
|
| 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
|
|
|
METATARSAL DECOMPRESS IMP SZ 4
|
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
|
|
|
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 |
$793.90 |
| Rate for Payer: Aetna Commercial |
$700.39
|
| Rate for Payer: Ambetter Exchange |
$403.57
|
| 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 Individual/Medicaid |
$403.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$403.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$484.28
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$403.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$403.57
|
| 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 |
$524.64
|
| Rate for Payer: UHCCP Medicaid |
$230.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$403.57
|
|
|
METATARSECTOMY
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 28140
|
| Hospital Charge Code |
76100988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| 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 |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
METATARSECTOMY
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 28140
|
| Hospital Charge Code |
76100988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
METATARSECTOMY(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 28140
|
| Hospital Charge Code |
761P0988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.41 |
| Max. Negotiated Rate |
$793.90 |
| Rate for Payer: Aetna Commercial |
$700.39
|
| Rate for Payer: Ambetter Exchange |
$403.57
|
| 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 Individual/Medicaid |
$403.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$403.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$484.28
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$403.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$403.57
|
| 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 |
$524.64
|
| Rate for Payer: UHCCP Medicaid |
$230.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$403.57
|
|
|
METER DOSE INH INITIAL
|
Facility
|
OP
|
$227.00
|
|
| Hospital Charge Code |
41000113
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$78.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$177.06
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$78.07
|
| Rate for Payer: Kentucky WC Medicaid |
$78.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
METER DOSE INH INITIAL
|
Professional
|
Both
|
$227.00
|
|
| Hospital Charge Code |
41000113
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$158.90 |
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Multiplan PHCS |
$136.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.90
|
| Rate for Payer: UHCCP Medicaid |
$79.45
|
|
|
METER DOSE INH INITIAL
|
Facility
|
IP
|
$227.00
|
|
| Hospital Charge Code |
41000113
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$177.06
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
METER DOSE INH SUBSQ
|
Professional
|
Both
|
$227.00
|
|
| Hospital Charge Code |
41000114
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$158.90 |
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Multiplan PHCS |
$136.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.90
|
| Rate for Payer: UHCCP Medicaid |
$79.45
|
|
|
METER DOSE INH SUBSQ
|
Facility
|
IP
|
$227.00
|
|
| Hospital Charge Code |
41000114
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$177.06
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
METER DOSE INH SUBSQ
|
Facility
|
OP
|
$227.00
|
|
| Hospital Charge Code |
41000114
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$78.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$177.06
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$78.07
|
| Rate for Payer: Kentucky WC Medicaid |
$78.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
METHADONE 10MG TABLET
|
Facility
|
IP
|
$60.10
|
|
|
Service Code
|
NDC 67877011601
|
| Hospital Charge Code |
25000968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$57.70 |
| Rate for Payer: Aetna Commercial |
$46.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.88
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cigna Commercial |
$49.88
|
| Rate for Payer: First Health Commercial |
$57.09
|
| Rate for Payer: Humana Commercial |
$51.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.89
|
| Rate for Payer: Ohio Health Group HMO |
$45.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.47
|
| Rate for Payer: PHCS Commercial |
$57.70
|
| Rate for Payer: United Healthcare All Payer |
$52.89
|
|
|
METHADONE 10MG TABLET
|
Facility
|
OP
|
$60.10
|
|
|
Service Code
|
NDC 67877011601
|
| Hospital Charge Code |
25000968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$57.70 |
| Rate for Payer: Aetna Commercial |
$46.28
|
| Rate for Payer: Anthem Medicaid |
$20.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.88
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cigna Commercial |
$49.88
|
| Rate for Payer: First Health Commercial |
$57.09
|
| Rate for Payer: Humana Commercial |
$51.09
|
| Rate for Payer: Humana KY Medicaid |
$20.67
|
| Rate for Payer: Kentucky WC Medicaid |
$20.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.89
|
| Rate for Payer: Ohio Health Group HMO |
$45.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.47
|
| Rate for Payer: PHCS Commercial |
$57.70
|
| Rate for Payer: United Healthcare All Payer |
$52.89
|
|
|
METHADONE 40MG/4ML ORAL LIQ
|
Facility
|
OP
|
$62.70
|
|
|
Service Code
|
NDC 527192736
|
| Hospital Charge Code |
25004474
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$60.19 |
| Rate for Payer: Aetna Commercial |
$48.28
|
| Rate for Payer: Anthem Medicaid |
$21.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.91
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cigna Commercial |
$52.04
|
| Rate for Payer: First Health Commercial |
$59.56
|
| Rate for Payer: Humana Commercial |
$53.30
|
| Rate for Payer: Humana KY Medicaid |
$21.56
|
| Rate for Payer: Kentucky WC Medicaid |
$21.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.18
|
| Rate for Payer: Ohio Health Group HMO |
$47.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.26
|
| Rate for Payer: PHCS Commercial |
$60.19
|
| Rate for Payer: United Healthcare All Payer |
$55.18
|
|
|
METHADONE 40MG/4ML ORAL LIQ
|
Facility
|
IP
|
$62.70
|
|
|
Service Code
|
NDC 527192736
|
| Hospital Charge Code |
25004474
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$60.19 |
| Rate for Payer: Aetna Commercial |
$48.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.91
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cigna Commercial |
$52.04
|
| Rate for Payer: First Health Commercial |
$59.56
|
| Rate for Payer: Humana Commercial |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.18
|
| Rate for Payer: Ohio Health Group HMO |
$47.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.26
|
| Rate for Payer: PHCS Commercial |
$60.19
|
| Rate for Payer: United Healthcare All Payer |
$55.18
|
|
|
METHADONE 40MG TABLET SOL
|
Facility
|
OP
|
$60.26
|
|
|
Service Code
|
NDC 406054034
|
| Hospital Charge Code |
25000970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Anthem Medicaid |
$20.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.00
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna Commercial |
$50.02
|
| Rate for Payer: First Health Commercial |
$57.25
|
| Rate for Payer: Humana Commercial |
$51.22
|
| Rate for Payer: Humana KY Medicaid |
$20.72
|
| Rate for Payer: Kentucky WC Medicaid |
$20.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.03
|
| Rate for Payer: Ohio Health Group HMO |
$45.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.58
|
| Rate for Payer: PHCS Commercial |
$57.85
|
| Rate for Payer: United Healthcare All Payer |
$53.03
|
|
|
METHADONE 40MG TABLET SOL
|
Facility
|
IP
|
$60.26
|
|
|
Service Code
|
NDC 406054034
|
| Hospital Charge Code |
25000970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.00
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna Commercial |
$50.02
|
| Rate for Payer: First Health Commercial |
$57.25
|
| Rate for Payer: Humana Commercial |
$51.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.03
|
| Rate for Payer: Ohio Health Group HMO |
$45.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.58
|
| Rate for Payer: PHCS Commercial |
$57.85
|
| Rate for Payer: United Healthcare All Payer |
$53.03
|
|
|
METHEMOGLOBIN QUANT
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 83050
|
| Hospital Charge Code |
30000364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$8.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.20
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Humana KY Medicaid |
$8.20
|
| Rate for Payer: Humana Medicare Advantage |
$8.20
|
| Rate for Payer: Kentucky WC Medicaid |
$8.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
METHEMOGLOBIN QUANT
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 83050
|
| Hospital Charge Code |
30000364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
