|
R3 MULTI-HOLE ACET SHELL 56MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
R3 MULTI-HOLE ACET SHELL 58MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
R3 MULTI-HOLE ACET SHELL 58MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
R3 MULTI-HOLE ACET SHELL 60MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
R3 MULTI-HOLE ACET SHELL 60MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
R3 MULTI-HOLE ACET SHELL 62MM
|
Facility
|
OP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem Medicaid |
$7,926.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Humana KY Medicaid |
$7,926.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,007.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,085.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
R3 MULTI-HOLE ACET SHELL 62MM
|
Facility
|
IP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
R3 MULTI-HOLE ACET SHELL 64MM
|
Facility
|
OP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem Medicaid |
$7,926.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Humana KY Medicaid |
$7,926.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,007.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,085.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
R3 MULTI-HOLE ACET SHELL 64MM
|
Facility
|
IP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
R3 MULTI-HOLE ACET SHELL 66MM
|
Facility
|
OP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem Medicaid |
$7,926.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Humana KY Medicaid |
$7,926.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,007.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,085.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
R3 MULTI-HOLE ACET SHELL 66MM
|
Facility
|
IP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
R3 MULTI-HOLE ACET SHELL 68MM
|
Facility
|
OP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem Medicaid |
$7,926.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Humana KY Medicaid |
$7,926.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,007.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,085.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
R3 MULTI-HOLE ACET SHELL 68MM
|
Facility
|
IP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
RABAVERT 2.5U SDV
|
Facility
|
IP
|
$1,039.59
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
770T0028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$998.01 |
| Rate for Payer: Aetna Commercial |
$800.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$810.88
|
| Rate for Payer: Cash Price |
$519.80
|
| Rate for Payer: Cigna Commercial |
$862.86
|
| Rate for Payer: First Health Commercial |
$987.61
|
| Rate for Payer: Humana Commercial |
$883.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$311.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$914.84
|
| Rate for Payer: Ohio Health Group HMO |
$779.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.27
|
| Rate for Payer: PHCS Commercial |
$998.01
|
| Rate for Payer: United Healthcare All Payer |
$914.84
|
|
|
RABAVERT 2.5U SDV
|
Facility
|
IP
|
$1,039.59
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
77000028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$998.01 |
| Rate for Payer: Aetna Commercial |
$800.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$810.88
|
| Rate for Payer: Cash Price |
$519.80
|
| Rate for Payer: Cigna Commercial |
$862.86
|
| Rate for Payer: First Health Commercial |
$987.61
|
| Rate for Payer: Humana Commercial |
$883.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$311.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$914.84
|
| Rate for Payer: Ohio Health Group HMO |
$779.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.27
|
| Rate for Payer: PHCS Commercial |
$998.01
|
| Rate for Payer: United Healthcare All Payer |
$914.84
|
|
|
RABAVERT 2.5U SDV
|
Facility
|
OP
|
$1,039.59
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
770T0028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$998.01 |
| Rate for Payer: Aetna Commercial |
$800.48
|
| Rate for Payer: Anthem Medicaid |
$357.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$324.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$810.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$454.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$438.40
|
| Rate for Payer: Cash Price |
$519.80
|
| Rate for Payer: Cash Price |
$519.80
|
| Rate for Payer: Cigna Commercial |
$862.86
|
| Rate for Payer: First Health Commercial |
$987.61
|
| Rate for Payer: Humana Commercial |
$883.65
|
| Rate for Payer: Humana KY Medicaid |
$357.52
|
| Rate for Payer: Humana Medicare Advantage |
$324.74
|
| Rate for Payer: Kentucky WC Medicaid |
$361.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$389.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$364.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$914.84
|
| Rate for Payer: Ohio Health Group HMO |
$779.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.27
|
| Rate for Payer: PHCS Commercial |
$998.01
|
| Rate for Payer: United Healthcare All Payer |
$914.84
|
|
|
RABAVERT 2.5U SDV
|
Facility
|
OP
|
$1,039.59
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
77000028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$998.01 |
| Rate for Payer: Aetna Commercial |
$800.48
|
| Rate for Payer: Anthem Medicaid |
$357.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$324.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$810.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$454.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$438.40
|
| Rate for Payer: Cash Price |
$519.80
|
| Rate for Payer: Cash Price |
$519.80
|
| Rate for Payer: Cigna Commercial |
$862.86
|
| Rate for Payer: First Health Commercial |
$987.61
|
| Rate for Payer: Humana Commercial |
$883.65
|
| Rate for Payer: Humana KY Medicaid |
$357.52
|
| Rate for Payer: Humana Medicare Advantage |
$324.74
|
| Rate for Payer: Kentucky WC Medicaid |
$361.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$389.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$364.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$914.84
|
| Rate for Payer: Ohio Health Group HMO |
$779.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.27
|
| Rate for Payer: PHCS Commercial |
$998.01
|
| Rate for Payer: United Healthcare All Payer |
$914.84
|
|
|
RABAVERT 2.5U SDV
|
Professional
|
Both
|
$1,039.59
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
77000028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$363.86 |
| Max. Negotiated Rate |
$1,039.59 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,039.59
|
| Rate for Payer: Cash Price |
$519.80
|
| Rate for Payer: Cash Price |
$519.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$629.84
|
| Rate for Payer: Multiplan PHCS |
$623.75
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$727.71
|
| Rate for Payer: UHCCP Medicaid |
$363.86
|
|
|
RABAVERT RABIES (VAC) 2.5ML
|
Facility
|
IP
|
$993.91
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
25000023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$954.15 |
| Rate for Payer: Aetna Commercial |
$765.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$775.25
|
| Rate for Payer: Cash Price |
$496.96
|
| Rate for Payer: Cigna Commercial |
$824.95
|
| Rate for Payer: First Health Commercial |
$944.21
|
| Rate for Payer: Humana Commercial |
$844.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$733.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$874.64
|
| Rate for Payer: Ohio Health Group HMO |
$745.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$308.11
|
| Rate for Payer: PHCS Commercial |
$954.15
|
| Rate for Payer: United Healthcare All Payer |
$874.64
|
|
|
RABAVERT RABIES (VAC) 2.5ML
|
Facility
|
OP
|
$993.91
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
25000023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$954.15 |
| Rate for Payer: Aetna Commercial |
$765.31
|
| Rate for Payer: Anthem Medicaid |
$341.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$324.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$775.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$454.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$438.40
|
| Rate for Payer: Cash Price |
$496.96
|
| Rate for Payer: Cash Price |
$496.96
|
| Rate for Payer: Cigna Commercial |
$824.95
|
| Rate for Payer: First Health Commercial |
$944.21
|
| Rate for Payer: Humana Commercial |
$844.82
|
| Rate for Payer: Humana KY Medicaid |
$341.81
|
| Rate for Payer: Humana Medicare Advantage |
$324.74
|
| Rate for Payer: Kentucky WC Medicaid |
$345.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$733.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$389.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$348.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$874.64
|
| Rate for Payer: Ohio Health Group HMO |
$745.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$308.11
|
| Rate for Payer: PHCS Commercial |
$954.15
|
| Rate for Payer: United Healthcare All Payer |
$874.64
|
|
|
RACEPINEPHRINE 2.25% 0.5 ML
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS J7699
|
| Hospital Charge Code |
25001286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.80
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.30
|
| Rate for Payer: First Health Commercial |
$9.50
|
| Rate for Payer: Humana Commercial |
$8.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.80
|
| Rate for Payer: Ohio Health Group HMO |
$7.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Payer |
$8.80
|
|
|
RACEPINEPHRINE 2.25% 0.5 ML
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J7699
|
| Hospital Charge Code |
25001286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Anthem Medicaid |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.80
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.30
|
| Rate for Payer: First Health Commercial |
$9.50
|
| Rate for Payer: Humana Commercial |
$8.50
|
| Rate for Payer: Humana KY Medicaid |
$3.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.80
|
| Rate for Payer: Ohio Health Group HMO |
$7.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Payer |
$8.80
|
|
|
RAD ART PSEUDOANEURYSM RPR
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,190.00
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$714.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$833.00
|
| Rate for Payer: UHCCP Medicaid |
$416.50
|
|
|
RADIAL HEAD CONSTRUCT 20MM*12M
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HEAD CONSTRUCT 20MM*12M
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
