|
ROPIVACAINE 0.2% 1MG/ML SDV
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
636T0201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.00
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna Commercial |
$3.20
|
| Rate for Payer: First Health Commercial |
$3.66
|
| Rate for Payer: Humana Commercial |
$3.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.39
|
| Rate for Payer: Ohio Health Group HMO |
$2.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.19
|
| Rate for Payer: PHCS Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Payer |
$3.39
|
|
|
ROPIVACAINE 0.2% 1MG/MLSDV
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.00
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna Commercial |
$3.20
|
| Rate for Payer: First Health Commercial |
$3.66
|
| Rate for Payer: Humana Commercial |
$3.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.39
|
| Rate for Payer: Ohio Health Group HMO |
$2.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.19
|
| Rate for Payer: PHCS Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Payer |
$3.39
|
|
|
ROPIVACAINE 0.2% 1MG/MLSDV
|
Facility
|
OP
|
$3.85
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Anthem Medicaid |
$1.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.00
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna Commercial |
$3.20
|
| Rate for Payer: First Health Commercial |
$3.66
|
| Rate for Payer: Humana Commercial |
$3.27
|
| Rate for Payer: Humana KY Medicaid |
$1.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.39
|
| Rate for Payer: Ohio Health Group HMO |
$2.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.19
|
| Rate for Payer: PHCS Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Payer |
$3.39
|
|
|
ROPIVACAINE 0.2% 1MG/MLSDV
|
Professional
|
Both
|
$3.85
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna Commercial |
$0.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.85
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Healthspan PPO |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.11
|
| Rate for Payer: Multiplan PHCS |
$2.31
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.70
|
| Rate for Payer: UHCCP Medicaid |
$1.35
|
|
|
ROPIVACAINE 0.2% PF 10mL SDV
|
Facility
|
IP
|
$80.09
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25004287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$76.89 |
| Rate for Payer: Aetna Commercial |
$61.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.47
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cigna Commercial |
$66.47
|
| Rate for Payer: First Health Commercial |
$76.09
|
| Rate for Payer: Humana Commercial |
$68.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.48
|
| Rate for Payer: Ohio Health Group HMO |
$60.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.83
|
| Rate for Payer: PHCS Commercial |
$76.89
|
| Rate for Payer: United Healthcare All Payer |
$70.48
|
|
|
ROPIVACAINE 0.2% PF 10mL SDV
|
Facility
|
OP
|
$80.09
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25004287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$76.89 |
| Rate for Payer: Aetna Commercial |
$61.67
|
| Rate for Payer: Anthem Medicaid |
$27.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.47
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cigna Commercial |
$66.47
|
| Rate for Payer: First Health Commercial |
$76.09
|
| Rate for Payer: Humana Commercial |
$68.08
|
| Rate for Payer: Humana KY Medicaid |
$27.54
|
| Rate for Payer: Kentucky WC Medicaid |
$27.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.48
|
| Rate for Payer: Ohio Health Group HMO |
$60.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.83
|
| Rate for Payer: PHCS Commercial |
$76.89
|
| Rate for Payer: United Healthcare All Payer |
$70.48
|
|
|
ROPIVACAINE 0.2% PF BAG 200ML
|
Facility
|
IP
|
$346.25
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25003758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$332.40 |
| Rate for Payer: Aetna Commercial |
$266.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$270.08
|
| Rate for Payer: Cash Price |
$173.12
|
| Rate for Payer: Cigna Commercial |
$287.39
|
| Rate for Payer: First Health Commercial |
$328.94
|
| Rate for Payer: Humana Commercial |
$294.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$283.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$255.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$304.70
|
| Rate for Payer: Ohio Health Group HMO |
$259.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.34
|
| Rate for Payer: PHCS Commercial |
$332.40
|
| Rate for Payer: United Healthcare All Payer |
$304.70
|
|
|
ROPIVACAINE 0.2% PF BAG 200ML
|
Facility
|
OP
|
$346.25
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25003758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$332.40 |
| Rate for Payer: Aetna Commercial |
$266.61
|
| Rate for Payer: Anthem Medicaid |
$119.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$270.08
|
| Rate for Payer: Cash Price |
$173.12
|
| Rate for Payer: Cigna Commercial |
$287.39
|
| Rate for Payer: First Health Commercial |
$328.94
|
| Rate for Payer: Humana Commercial |
$294.31
|
| Rate for Payer: Humana KY Medicaid |
$119.08
|
| Rate for Payer: Kentucky WC Medicaid |
$120.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$283.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$255.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$304.70
|
| Rate for Payer: Ohio Health Group HMO |
$259.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.34
|
| Rate for Payer: PHCS Commercial |
$332.40
|
| Rate for Payer: United Healthcare All Payer |
$304.70
|
|
|
ROPIVACAINE 0.5% 1MG 5MG/MLSDV
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna Commercial |
$0.57
|
| Rate for Payer: Anthem Medicaid |
$0.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna Commercial |
$0.61
|
| Rate for Payer: First Health Commercial |
$0.70
|
| Rate for Payer: Humana Commercial |
$0.63
|
| Rate for Payer: Humana KY Medicaid |
$0.25
|
| Rate for Payer: Kentucky WC Medicaid |
$0.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.65
|
| Rate for Payer: Ohio Health Group HMO |
$0.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.23
|
| Rate for Payer: PHCS Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Payer |
$0.65
|
|
|
ROPIVACAINE 0.5% 1MG 5MG/MLSDV
|
Professional
|
Both
|
$0.74
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna Commercial |
$0.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.74
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Healthspan PPO |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.11
|
| Rate for Payer: Multiplan PHCS |
$0.44
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.52
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
|
|
ROPIVACAINE 0.5% 1MG 5MG/MLSDV
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
636T0202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna Commercial |
$0.57
|
| Rate for Payer: Anthem Medicaid |
$0.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna Commercial |
$0.61
|
| Rate for Payer: First Health Commercial |
$0.70
|
| Rate for Payer: Humana Commercial |
$0.63
|
| Rate for Payer: Humana KY Medicaid |
$0.25
|
| Rate for Payer: Kentucky WC Medicaid |
$0.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.65
|
| Rate for Payer: Ohio Health Group HMO |
$0.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.23
|
| Rate for Payer: PHCS Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Payer |
$0.65
|
|
|
ROPIVACAINE 0.5% 1MG 5MG/MLSDV
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
636T0202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna Commercial |
$0.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna Commercial |
$0.61
|
| Rate for Payer: First Health Commercial |
$0.70
|
| Rate for Payer: Humana Commercial |
$0.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.65
|
| Rate for Payer: Ohio Health Group HMO |
$0.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.23
|
| Rate for Payer: PHCS Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Payer |
$0.65
|
|
|
ROPIVACAINE 0.5% 1MG 5MG/MLSDV
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna Commercial |
$0.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna Commercial |
$0.61
|
| Rate for Payer: First Health Commercial |
$0.70
|
| Rate for Payer: Humana Commercial |
$0.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.65
|
| Rate for Payer: Ohio Health Group HMO |
$0.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.23
|
| Rate for Payer: PHCS Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Payer |
$0.65
|
|
|
ROPIVACAINE 0.5% PF VL (20ML)
|
Facility
|
OP
|
$78.68
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25003759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$75.53 |
| Rate for Payer: Aetna Commercial |
$60.58
|
| Rate for Payer: Anthem Medicaid |
$27.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.37
|
| Rate for Payer: Cash Price |
$39.34
|
| Rate for Payer: Cigna Commercial |
$65.30
|
| Rate for Payer: First Health Commercial |
$74.75
|
| Rate for Payer: Humana Commercial |
$66.88
|
| Rate for Payer: Humana KY Medicaid |
$27.06
|
| Rate for Payer: Kentucky WC Medicaid |
$27.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.24
|
| Rate for Payer: Ohio Health Group HMO |
$59.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.39
|
| Rate for Payer: PHCS Commercial |
$75.53
|
| Rate for Payer: United Healthcare All Payer |
$69.24
|
|
|
ROPIVACAINE 0.5% PF VL (20ML)
|
Facility
|
IP
|
$78.68
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25003759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$75.53 |
| Rate for Payer: Aetna Commercial |
$60.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.37
|
| Rate for Payer: Cash Price |
$39.34
|
| Rate for Payer: Cigna Commercial |
$65.30
|
| Rate for Payer: First Health Commercial |
$74.75
|
| Rate for Payer: Humana Commercial |
$66.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.24
|
| Rate for Payer: Ohio Health Group HMO |
$59.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.39
|
| Rate for Payer: PHCS Commercial |
$75.53
|
| Rate for Payer: United Healthcare All Payer |
$69.24
|
|
|
ROTALINK BURR 1.75MM
|
Facility
|
IP
|
$9,826.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.41 |
| Max. Negotiated Rate |
$9,433.20 |
| Rate for Payer: Aetna Commercial |
$7,566.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.48
|
| Rate for Payer: Cash Price |
$4,913.12
|
| Rate for Payer: Cigna Commercial |
$8,155.79
|
| Rate for Payer: First Health Commercial |
$9,334.94
|
| Rate for Payer: Humana Commercial |
$8,352.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,251.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,947.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,369.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,046.14
|
| Rate for Payer: PHCS Commercial |
$9,433.20
|
| Rate for Payer: United Healthcare All Payer |
$8,647.10
|
|
|
ROTALINK BURR 1.75MM
|
Facility
|
OP
|
$9,826.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.41 |
| Max. Negotiated Rate |
$9,433.20 |
| Rate for Payer: Aetna Commercial |
$7,566.21
|
| Rate for Payer: Anthem Medicaid |
$3,379.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.48
|
| Rate for Payer: Cash Price |
$4,913.12
|
| Rate for Payer: Cigna Commercial |
$8,155.79
|
| Rate for Payer: First Health Commercial |
$9,334.94
|
| Rate for Payer: Humana Commercial |
$8,352.31
|
| Rate for Payer: Humana KY Medicaid |
$3,379.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,413.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,251.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,947.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,369.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,046.14
|
| Rate for Payer: PHCS Commercial |
$9,433.20
|
| Rate for Payer: United Healthcare All Payer |
$8,647.10
|
|
|
ROTALINK PLUS 1.25MM
|
Facility
|
IP
|
$9,826.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.41 |
| Max. Negotiated Rate |
$9,433.20 |
| Rate for Payer: Aetna Commercial |
$7,566.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.48
|
| Rate for Payer: Cash Price |
$4,913.12
|
| Rate for Payer: Cigna Commercial |
$8,155.79
|
| Rate for Payer: First Health Commercial |
$9,334.94
|
| Rate for Payer: Humana Commercial |
$8,352.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,251.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,947.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,369.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,046.14
|
| Rate for Payer: PHCS Commercial |
$9,433.20
|
| Rate for Payer: United Healthcare All Payer |
$8,647.10
|
|
|
ROTALINK PLUS 1.25MM
|
Facility
|
OP
|
$9,826.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.41 |
| Max. Negotiated Rate |
$9,433.20 |
| Rate for Payer: Aetna Commercial |
$7,566.21
|
| Rate for Payer: Anthem Medicaid |
$3,379.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.48
|
| Rate for Payer: Cash Price |
$4,913.12
|
| Rate for Payer: Cigna Commercial |
$8,155.79
|
| Rate for Payer: First Health Commercial |
$9,334.94
|
| Rate for Payer: Humana Commercial |
$8,352.31
|
| Rate for Payer: Humana KY Medicaid |
$3,379.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,413.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,251.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,947.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,369.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,046.14
|
| Rate for Payer: PHCS Commercial |
$9,433.20
|
| Rate for Payer: United Healthcare All Payer |
$8,647.10
|
|
|
ROTALINK PLUS 1.50MM
|
Facility
|
OP
|
$9,826.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.41 |
| Max. Negotiated Rate |
$9,433.20 |
| Rate for Payer: Aetna Commercial |
$7,566.21
|
| Rate for Payer: Anthem Medicaid |
$3,379.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.48
|
| Rate for Payer: Cash Price |
$4,913.12
|
| Rate for Payer: Cigna Commercial |
$8,155.79
|
| Rate for Payer: First Health Commercial |
$9,334.94
|
| Rate for Payer: Humana Commercial |
$8,352.31
|
| Rate for Payer: Humana KY Medicaid |
$3,379.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,413.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,251.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,947.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,369.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,046.14
|
| Rate for Payer: PHCS Commercial |
$9,433.20
|
| Rate for Payer: United Healthcare All Payer |
$8,647.10
|
|
|
ROTALINK PLUS 1.50MM
|
Facility
|
IP
|
$9,826.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.41 |
| Max. Negotiated Rate |
$9,433.20 |
| Rate for Payer: Aetna Commercial |
$7,566.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.48
|
| Rate for Payer: Cash Price |
$4,913.12
|
| Rate for Payer: Cigna Commercial |
$8,155.79
|
| Rate for Payer: First Health Commercial |
$9,334.94
|
| Rate for Payer: Humana Commercial |
$8,352.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,251.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,947.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,369.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,046.14
|
| Rate for Payer: PHCS Commercial |
$9,433.20
|
| Rate for Payer: United Healthcare All Payer |
$8,647.10
|
|
|
ROTAREX SET 6F 135CM
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
ROTAREX SET 6F 135CM
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
ROTAREX SET 8F 110CM
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
ROTAREX SET 8F 110CM
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
