|
RINGLOC REPLCMNT RING SZ 27
|
Facility
|
IP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
|
RINGLOC REPLCMNT RING SZ 27
|
Facility
|
OP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem Medicaid |
$698.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Humana KY Medicaid |
$698.25
|
| Rate for Payer: Kentucky WC Medicaid |
$705.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
|
RING RINGLOC LOCKING SZ 20
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 20
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 21
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 21
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 22
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 22
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 23
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 23
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 24
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 24
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 25
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 25
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 26
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 26
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 27
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 27
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 28
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RING RINGLOC LOCKING SZ 28
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
RISPERDAL 0.25MG TABLET
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 68382011214
|
| Hospital Charge Code |
25001334
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
RISPERDAL 0.25MG TABLET
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 68382011214
|
| Hospital Charge Code |
25001334
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
RISPERDAL(0.5MG)12.5MG ER SYR
|
Facility
|
IP
|
$64.54
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$61.96 |
| Rate for Payer: Aetna Commercial |
$49.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.34
|
| Rate for Payer: Cash Price |
$32.27
|
| Rate for Payer: Cigna Commercial |
$53.57
|
| Rate for Payer: First Health Commercial |
$61.31
|
| Rate for Payer: Humana Commercial |
$54.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.80
|
| Rate for Payer: Ohio Health Group HMO |
$48.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.01
|
| Rate for Payer: PHCS Commercial |
$61.96
|
| Rate for Payer: United Healthcare All Payer |
$56.80
|
|
|
RISPERDAL(0.5MG)12.5MG ER SYR
|
Facility
|
OP
|
$64.54
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$61.96 |
| Rate for Payer: Aetna Commercial |
$49.70
|
| Rate for Payer: Anthem Medicaid |
$22.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
| Rate for Payer: Cash Price |
$32.27
|
| Rate for Payer: Cash Price |
$32.27
|
| Rate for Payer: Cigna Commercial |
$53.57
|
| Rate for Payer: First Health Commercial |
$61.31
|
| Rate for Payer: Humana Commercial |
$54.86
|
| Rate for Payer: Humana KY Medicaid |
$22.20
|
| Rate for Payer: Humana Medicare Advantage |
$12.15
|
| Rate for Payer: Kentucky WC Medicaid |
$22.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.80
|
| Rate for Payer: Ohio Health Group HMO |
$48.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.01
|
| Rate for Payer: PHCS Commercial |
$61.96
|
| Rate for Payer: United Healthcare All Payer |
$56.80
|
|
|
RISPERDAL(0.5MG)12.5MG ER SYR
|
Professional
|
Both
|
$64.54
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$64.54 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.54
|
| Rate for Payer: Cash Price |
$32.27
|
| Rate for Payer: Cash Price |
$32.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.93
|
| Rate for Payer: Multiplan PHCS |
$38.72
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.18
|
| Rate for Payer: UHCCP Medicaid |
$22.59
|
|
