|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
OP
|
$3,247.60
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
636T0032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$422.19 |
| Max. Negotiated Rate |
$3,117.70 |
| Rate for Payer: Aetna Commercial |
$2,500.65
|
| Rate for Payer: Anthem Medicaid |
$1,116.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$680.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,533.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$953.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$919.11
|
| Rate for Payer: Cash Price |
$1,623.80
|
| Rate for Payer: Cash Price |
$1,623.80
|
| Rate for Payer: Cigna Commercial |
$2,695.51
|
| Rate for Payer: First Health Commercial |
$3,085.22
|
| Rate for Payer: Humana Commercial |
$2,760.46
|
| Rate for Payer: Humana KY Medicaid |
$1,116.85
|
| Rate for Payer: Humana Medicare Advantage |
$680.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,128.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,663.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,396.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$816.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,139.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,857.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,435.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.76
|
| Rate for Payer: PHCS Commercial |
$3,117.70
|
| Rate for Payer: United Healthcare All Payer |
$2,857.89
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
OP
|
$3,787.64
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
25002036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$492.39 |
| Max. Negotiated Rate |
$3,636.13 |
| Rate for Payer: Aetna Commercial |
$2,916.48
|
| Rate for Payer: Anthem Medicaid |
$1,302.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$680.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,954.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$953.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$919.11
|
| Rate for Payer: Cash Price |
$1,893.82
|
| Rate for Payer: Cash Price |
$1,893.82
|
| Rate for Payer: Cigna Commercial |
$3,143.74
|
| Rate for Payer: First Health Commercial |
$3,598.26
|
| Rate for Payer: Humana Commercial |
$3,219.49
|
| Rate for Payer: Humana KY Medicaid |
$1,302.57
|
| Rate for Payer: Humana Medicare Advantage |
$680.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,315.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,105.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,795.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$816.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,328.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,333.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,840.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$757.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.17
|
| Rate for Payer: PHCS Commercial |
$3,636.13
|
| Rate for Payer: United Healthcare All Payer |
$3,333.12
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
IP
|
$3,787.64
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
25002036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$492.39 |
| Max. Negotiated Rate |
$3,636.13 |
| Rate for Payer: Aetna Commercial |
$2,916.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,954.36
|
| Rate for Payer: Cash Price |
$1,893.82
|
| Rate for Payer: Cigna Commercial |
$3,143.74
|
| Rate for Payer: First Health Commercial |
$3,598.26
|
| Rate for Payer: Humana Commercial |
$3,219.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,105.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,795.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,333.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,840.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$757.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.17
|
| Rate for Payer: PHCS Commercial |
$3,636.13
|
| Rate for Payer: United Healthcare All Payer |
$3,333.12
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
IP
|
$3,247.60
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
63600032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$422.19 |
| Max. Negotiated Rate |
$3,117.70 |
| Rate for Payer: Aetna Commercial |
$2,500.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,533.13
|
| Rate for Payer: Cash Price |
$1,623.80
|
| Rate for Payer: Cigna Commercial |
$2,695.51
|
| Rate for Payer: First Health Commercial |
$3,085.22
|
| Rate for Payer: Humana Commercial |
$2,760.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,663.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,396.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,857.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,435.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.76
|
| Rate for Payer: PHCS Commercial |
$3,117.70
|
| Rate for Payer: United Healthcare All Payer |
$2,857.89
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Professional
|
Both
|
$3,247.60
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
63600032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$871.47 |
| Max. Negotiated Rate |
$3,247.60 |
| Rate for Payer: Aetna Commercial |
$871.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,247.60
|
| Rate for Payer: Cash Price |
$1,623.80
|
| Rate for Payer: Cash Price |
$1,623.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$903.55
|
| Rate for Payer: Multiplan PHCS |
$1,948.56
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,273.32
|
| Rate for Payer: UHCCP Medicaid |
$1,136.66
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
IP
|
$3,247.60
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
636T0032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$422.19 |
| Max. Negotiated Rate |
$3,117.70 |
| Rate for Payer: Aetna Commercial |
$2,500.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,533.13
|
| Rate for Payer: Cash Price |
$1,623.80
|
| Rate for Payer: Cigna Commercial |
$2,695.51
|
| Rate for Payer: First Health Commercial |
$3,085.22
|
| Rate for Payer: Humana Commercial |
$2,760.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,663.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,396.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,857.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,435.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.76
|
| Rate for Payer: PHCS Commercial |
$3,117.70
|
| Rate for Payer: United Healthcare All Payer |
$2,857.89
|
|
|
RING CONT RECN TRL 50/46 RT
|
Facility
|
OP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem Medicaid |
$1,136.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Humana KY Medicaid |
$1,136.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 50/46 RT
|
Facility
|
IP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 56/52 RT
|
Facility
|
IP
|
$3,400.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.06 |
| Max. Negotiated Rate |
$3,264.48 |
| Rate for Payer: Aetna Commercial |
$2,618.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.39
|
| Rate for Payer: Cash Price |
$1,700.25
|
| Rate for Payer: Cigna Commercial |
$2,822.42
|
| Rate for Payer: First Health Commercial |
$3,230.48
|
| Rate for Payer: Humana Commercial |
$2,890.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.16
|
| Rate for Payer: PHCS Commercial |
$3,264.48
|
| Rate for Payer: United Healthcare All Payer |
$2,992.44
|
|
|
RING CONT RECN TRL 56/52 RT
|
Facility
|
OP
|
$3,400.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.06 |
| Max. Negotiated Rate |
$3,264.48 |
| Rate for Payer: Aetna Commercial |
$2,618.38
|
| Rate for Payer: Anthem Medicaid |
$1,169.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.39
|
| Rate for Payer: Cash Price |
$1,700.25
|
| Rate for Payer: Cigna Commercial |
$2,822.42
|
| Rate for Payer: First Health Commercial |
$3,230.48
|
| Rate for Payer: Humana Commercial |
$2,890.42
|
| Rate for Payer: Humana KY Medicaid |
$1,169.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,181.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,192.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.16
|
| Rate for Payer: PHCS Commercial |
$3,264.48
|
| Rate for Payer: United Healthcare All Payer |
$2,992.44
|
|
|
RING CONT RECN TRL 62/58 LT
|
Facility
|
IP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 62/58 LT
|
Facility
|
OP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem Medicaid |
$1,136.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Humana KY Medicaid |
$1,136.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 62/58 RT
|
Facility
|
OP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem Medicaid |
$1,136.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Humana KY Medicaid |
$1,136.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 62/58 RT
|
Facility
|
IP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 64ID 68OD L
|
Facility
|
OP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem Medicaid |
$1,136.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Humana KY Medicaid |
$1,136.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 64ID 68OD L
|
Facility
|
IP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 64ID 68OD R
|
Facility
|
OP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem Medicaid |
$1,136.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Humana KY Medicaid |
$1,136.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 64ID 68OD R
|
Facility
|
IP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 70ID 74OD L
|
Facility
|
IP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 70ID 74OD L
|
Facility
|
OP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem Medicaid |
$1,136.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Humana KY Medicaid |
$1,136.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 70ID 74OD R
|
Facility
|
IP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RING CONT RECN TRL 70ID 74OD R
|
Facility
|
OP
|
$3,305.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$3,173.42 |
| Rate for Payer: Aetna Commercial |
$2,545.35
|
| Rate for Payer: Anthem Medicaid |
$1,136.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,578.41
|
| Rate for Payer: Cash Price |
$1,652.83
|
| Rate for Payer: Cigna Commercial |
$2,743.69
|
| Rate for Payer: First Health Commercial |
$3,140.37
|
| Rate for Payer: Humana Commercial |
$2,809.80
|
| Rate for Payer: Humana KY Medicaid |
$1,136.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,479.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.75
|
| Rate for Payer: PHCS Commercial |
$3,173.42
|
| Rate for Payer: United Healthcare All Payer |
$2,908.97
|
|
|
RINGERS IRRIGATION SOLU 1000ML
|
Facility
|
IP
|
$23.33
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.20
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cigna Commercial |
$19.36
|
| Rate for Payer: First Health Commercial |
$22.16
|
| Rate for Payer: Humana Commercial |
$19.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.53
|
| Rate for Payer: Ohio Health Group HMO |
$17.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.23
|
| Rate for Payer: PHCS Commercial |
$22.40
|
| Rate for Payer: United Healthcare All Payer |
$20.53
|
|
|
RINGERS IRRIGATION SOLU 1000ML
|
Facility
|
OP
|
$23.33
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Anthem Medicaid |
$8.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.20
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cigna Commercial |
$19.36
|
| Rate for Payer: First Health Commercial |
$22.16
|
| Rate for Payer: Humana Commercial |
$19.83
|
| Rate for Payer: Humana KY Medicaid |
$8.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.53
|
| Rate for Payer: Ohio Health Group HMO |
$17.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.23
|
| Rate for Payer: PHCS Commercial |
$22.40
|
| Rate for Payer: United Healthcare All Payer |
$20.53
|
|
|
RING LOC BI-POLAR CUP 28/42
|
Facility
|
OP
|
$6,884.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.97 |
| Max. Negotiated Rate |
$6,608.98 |
| Rate for Payer: Aetna Commercial |
$5,300.95
|
| Rate for Payer: Anthem Medicaid |
$2,367.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,369.79
|
| Rate for Payer: Cash Price |
$3,442.18
|
| Rate for Payer: Cigna Commercial |
$5,714.01
|
| Rate for Payer: First Health Commercial |
$6,540.13
|
| Rate for Payer: Humana Commercial |
$5,851.70
|
| Rate for Payer: Humana KY Medicaid |
$2,367.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,391.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,645.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,080.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,058.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,163.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.15
|
| Rate for Payer: PHCS Commercial |
$6,608.98
|
| Rate for Payer: United Healthcare All Payer |
$6,058.23
|
|
