|
R3 MULTI-HOLE ACET SHELL 62MM
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
R3 MULTI-HOLE ACET SHELL 62MM
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem Medicaid |
$8,167.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Humana KY Medicaid |
$8,167.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,331.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
R3 MULTI-HOLE ACET SHELL 64MM
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem Medicaid |
$8,167.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Humana KY Medicaid |
$8,167.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,331.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
R3 MULTI-HOLE ACET SHELL 64MM
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
R3 MULTI-HOLE ACET SHELL 66MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
R3 MULTI-HOLE ACET SHELL 66MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
R3 MULTI-HOLE ACET SHELL 68MM
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
R3 MULTI-HOLE ACET SHELL 68MM
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem Medicaid |
$8,167.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Humana KY Medicaid |
$8,167.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,331.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
RABAVERT 2.5U SDV
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
770T0028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.03 |
| Max. Negotiated Rate |
$998.40 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem Medicaid |
$357.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$312.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$436.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.24
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Humana KY Medicaid |
$357.66
|
| Rate for Payer: Humana Medicare Advantage |
$312.03
|
| Rate for Payer: Kentucky WC Medicaid |
$361.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$374.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$364.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.60
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
RABAVERT 2.5U SDV
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
77000028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.03 |
| Max. Negotiated Rate |
$998.40 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem Medicaid |
$357.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$312.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$436.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.24
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Humana KY Medicaid |
$357.66
|
| Rate for Payer: Humana Medicare Advantage |
$312.03
|
| Rate for Payer: Kentucky WC Medicaid |
$361.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$374.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$364.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.60
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
RABAVERT 2.5U SDV
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
77000028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$998.40 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.60
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
RABAVERT 2.5U SDV
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
770T0028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$998.40 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.60
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
RABAVERT 2.5U SDV
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
77000028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.03 |
| Max. Negotiated Rate |
$629.84 |
| Rate for Payer: Ambetter Exchange |
$312.03
|
| Rate for Payer: Anthem Medicaid |
$382.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$312.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$312.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.44
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Humana Medicaid |
$382.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$312.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.98
|
| Rate for Payer: Molina Healthcare Passport |
$382.33
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$405.64
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$312.03
|
|
|
RABAVERT RABIES (VAC) 2.5ML
|
Facility
|
IP
|
$1,014.61
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
25000023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$304.38 |
| Max. Negotiated Rate |
$974.03 |
| Rate for Payer: Aetna Commercial |
$781.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$791.40
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$842.13
|
| Rate for Payer: First Health Commercial |
$963.88
|
| Rate for Payer: Humana Commercial |
$862.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$831.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$748.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$892.86
|
| Rate for Payer: Ohio Health Group HMO |
$760.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$811.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$700.08
|
| Rate for Payer: PHCS Commercial |
$974.03
|
| Rate for Payer: United Healthcare All Payer |
$892.86
|
|
|
RABAVERT RABIES (VAC) 2.5ML
|
Facility
|
OP
|
$1,014.61
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
25000023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.03 |
| Max. Negotiated Rate |
$974.03 |
| Rate for Payer: Aetna Commercial |
$781.25
|
| Rate for Payer: Anthem Medicaid |
$348.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$312.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$791.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$436.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.24
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$842.13
|
| Rate for Payer: First Health Commercial |
$963.88
|
| Rate for Payer: Humana Commercial |
$862.42
|
| Rate for Payer: Humana KY Medicaid |
$348.92
|
| Rate for Payer: Humana Medicare Advantage |
$312.03
|
| Rate for Payer: Kentucky WC Medicaid |
$352.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$831.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$748.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$374.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$355.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$892.86
|
| Rate for Payer: Ohio Health Group HMO |
$760.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$811.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$700.08
|
| Rate for Payer: PHCS Commercial |
$974.03
|
| Rate for Payer: United Healthcare All Payer |
$892.86
|
|
|
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 |
$3.00 |
| 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 |
$8.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Payer |
$8.80
|
|
|
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 |
$3.00 |
| 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 |
$8.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| 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 |
$833.00 |
| 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
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
RADIAL HEAD CONSTRUCT 20MM*12M
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
RADIAL HEAD CONSTRUCT 24MM*12M
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
RADIAL HEAD CONSTRUCT 24MM*12M
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
RADIAL HEAD ENDO M 12MM
|
Facility
|
IP
|
$16,684.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,005.20 |
| Max. Negotiated Rate |
$16,016.64 |
| Rate for Payer: Aetna Commercial |
$12,846.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,013.52
|
| Rate for Payer: Cash Price |
$8,342.00
|
| Rate for Payer: Cigna Commercial |
$13,847.72
|
| Rate for Payer: First Health Commercial |
$15,849.80
|
| Rate for Payer: Humana Commercial |
$14,181.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,680.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,312.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,005.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,681.92
|
| Rate for Payer: Ohio Health Group HMO |
$12,513.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,347.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,515.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,511.96
|
| Rate for Payer: PHCS Commercial |
$16,016.64
|
| Rate for Payer: United Healthcare All Payer |
$14,681.92
|
|
|
RADIAL HEAD ENDO M 12MM
|
Facility
|
OP
|
$16,684.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,005.20 |
| Max. Negotiated Rate |
$16,016.64 |
| Rate for Payer: Aetna Commercial |
$12,846.68
|
| Rate for Payer: Anthem Medicaid |
$5,737.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,013.52
|
| Rate for Payer: Cash Price |
$8,342.00
|
| Rate for Payer: Cigna Commercial |
$13,847.72
|
| Rate for Payer: First Health Commercial |
$15,849.80
|
| Rate for Payer: Humana Commercial |
$14,181.40
|
| Rate for Payer: Humana KY Medicaid |
$5,737.63
|
| Rate for Payer: Kentucky WC Medicaid |
$5,796.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,680.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,312.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,005.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,852.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,681.92
|
| Rate for Payer: Ohio Health Group HMO |
$12,513.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,347.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,515.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,511.96
|
| Rate for Payer: PHCS Commercial |
$16,016.64
|
| Rate for Payer: United Healthcare All Payer |
$14,681.92
|
|
|
RADIAL HEAD ENDO M 15MM
|
Facility
|
OP
|
$16,684.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,005.20 |
| Max. Negotiated Rate |
$16,016.64 |
| Rate for Payer: Aetna Commercial |
$12,846.68
|
| Rate for Payer: Anthem Medicaid |
$5,737.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,013.52
|
| Rate for Payer: Cash Price |
$8,342.00
|
| Rate for Payer: Cigna Commercial |
$13,847.72
|
| Rate for Payer: First Health Commercial |
$15,849.80
|
| Rate for Payer: Humana Commercial |
$14,181.40
|
| Rate for Payer: Humana KY Medicaid |
$5,737.63
|
| Rate for Payer: Kentucky WC Medicaid |
$5,796.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,680.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,312.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,005.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,852.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,681.92
|
| Rate for Payer: Ohio Health Group HMO |
$12,513.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,347.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,515.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,511.96
|
| Rate for Payer: PHCS Commercial |
$16,016.64
|
| Rate for Payer: United Healthcare All Payer |
$14,681.92
|
|
