|
RETACRIT 3000 UNIT/ML VL
|
Facility
|
OP
|
$180.34
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
25002730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$173.13 |
| Rate for Payer: Aetna Commercial |
$138.86
|
| Rate for Payer: Anthem Medicaid |
$62.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.22
|
| Rate for Payer: Cash Price |
$90.17
|
| Rate for Payer: Cash Price |
$90.17
|
| Rate for Payer: Cigna Commercial |
$149.68
|
| Rate for Payer: First Health Commercial |
$171.32
|
| Rate for Payer: Humana Commercial |
$153.29
|
| Rate for Payer: Humana KY Medicaid |
$62.02
|
| Rate for Payer: Humana Medicare Advantage |
$7.57
|
| Rate for Payer: Kentucky WC Medicaid |
$62.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.70
|
| Rate for Payer: Ohio Health Group HMO |
$135.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.43
|
| Rate for Payer: PHCS Commercial |
$173.13
|
| Rate for Payer: United Healthcare All Payer |
$158.70
|
|
|
RETACRIT 3000 UNIT/ML VL
|
Facility
|
IP
|
$180.34
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
25002730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$173.13 |
| Rate for Payer: Aetna Commercial |
$138.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.67
|
| Rate for Payer: Cash Price |
$90.17
|
| Rate for Payer: Cigna Commercial |
$149.68
|
| Rate for Payer: First Health Commercial |
$171.32
|
| Rate for Payer: Humana Commercial |
$153.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.70
|
| Rate for Payer: Ohio Health Group HMO |
$135.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.43
|
| Rate for Payer: PHCS Commercial |
$173.13
|
| Rate for Payer: United Healthcare All Payer |
$158.70
|
|
|
RETACRIT 40000 UNIT/ML VIAL
|
Facility
|
IP
|
$2,404.54
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
25002732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$721.36 |
| Max. Negotiated Rate |
$2,308.36 |
| Rate for Payer: Aetna Commercial |
$1,851.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,875.54
|
| Rate for Payer: Cash Price |
$1,202.27
|
| Rate for Payer: Cigna Commercial |
$1,995.77
|
| Rate for Payer: First Health Commercial |
$2,284.31
|
| Rate for Payer: Humana Commercial |
$2,043.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,971.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,774.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$721.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,116.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,803.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,923.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,659.13
|
| Rate for Payer: PHCS Commercial |
$2,308.36
|
| Rate for Payer: United Healthcare All Payer |
$2,116.00
|
|
|
RETACRIT 40000 UNIT/ML VIAL
|
Facility
|
OP
|
$2,404.54
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
25002732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$2,308.36 |
| Rate for Payer: Aetna Commercial |
$1,851.50
|
| Rate for Payer: Anthem Medicaid |
$826.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,875.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.22
|
| Rate for Payer: Cash Price |
$1,202.27
|
| Rate for Payer: Cash Price |
$1,202.27
|
| Rate for Payer: Cigna Commercial |
$1,995.77
|
| Rate for Payer: First Health Commercial |
$2,284.31
|
| Rate for Payer: Humana Commercial |
$2,043.86
|
| Rate for Payer: Humana KY Medicaid |
$826.92
|
| Rate for Payer: Humana Medicare Advantage |
$7.57
|
| Rate for Payer: Kentucky WC Medicaid |
$835.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,971.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,774.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$843.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,116.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,803.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,923.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,659.13
|
| Rate for Payer: PHCS Commercial |
$2,308.36
|
| Rate for Payer: United Healthcare All Payer |
$2,116.00
|
|
|
RETACRIT 4000 UNIT/ML VL
|
Facility
|
IP
|
$240.45
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
25002731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$230.83 |
| Rate for Payer: Aetna Commercial |
$185.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.55
|
| Rate for Payer: Cash Price |
$120.22
|
| Rate for Payer: Cigna Commercial |
$199.57
|
| Rate for Payer: First Health Commercial |
$228.43
|
| Rate for Payer: Humana Commercial |
$204.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$197.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.60
|
| Rate for Payer: Ohio Health Group HMO |
$180.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.91
|
| Rate for Payer: PHCS Commercial |
$230.83
|
| Rate for Payer: United Healthcare All Payer |
$211.60
|
|
|
RETACRIT 4000 UNIT/ML VL
|
Facility
|
OP
|
$240.45
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
25002731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$230.83 |
| Rate for Payer: Aetna Commercial |
$185.15
|
| Rate for Payer: Anthem Medicaid |
$82.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.22
|
| Rate for Payer: Cash Price |
$120.22
|
| Rate for Payer: Cash Price |
$120.22
|
| Rate for Payer: Cigna Commercial |
$199.57
|
| Rate for Payer: First Health Commercial |
$228.43
|
| Rate for Payer: Humana Commercial |
$204.38
|
| Rate for Payer: Humana KY Medicaid |
$82.69
|
| Rate for Payer: Humana Medicare Advantage |
$7.57
|
| Rate for Payer: Kentucky WC Medicaid |
$83.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$197.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.60
|
| Rate for Payer: Ohio Health Group HMO |
$180.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.91
|
| Rate for Payer: PHCS Commercial |
$230.83
|
| Rate for Payer: United Healthcare All Payer |
$211.60
|
|
|
RETICULOCYTE COUNT
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
30000572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$37.44 |
| Rate for Payer: Aetna Commercial |
$30.03
|
| Rate for Payer: Anthem Medicaid |
$3.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.99
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.37
|
| Rate for Payer: First Health Commercial |
$37.05
|
| Rate for Payer: Humana Commercial |
$33.15
|
| Rate for Payer: Humana KY Medicaid |
$3.99
|
| Rate for Payer: Humana Medicare Advantage |
$3.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.32
|
| Rate for Payer: Ohio Health Group HMO |
$29.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.91
|
| Rate for Payer: PHCS Commercial |
$37.44
|
| Rate for Payer: United Healthcare All Payer |
$34.32
|
|
|
RETICULOCYTE COUNT
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
30000572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$37.44 |
| Rate for Payer: Aetna Commercial |
$30.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.32
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.37
|
| Rate for Payer: First Health Commercial |
$37.05
|
| Rate for Payer: Humana Commercial |
$33.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.32
|
| Rate for Payer: Ohio Health Group HMO |
$29.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.91
|
| Rate for Payer: PHCS Commercial |
$37.44
|
| Rate for Payer: United Healthcare All Payer |
$34.32
|
|
|
RETROBUTTON LONG 15MM
|
Facility
|
OP
|
$2,193.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.90 |
| Max. Negotiated Rate |
$2,105.28 |
| Rate for Payer: Aetna Commercial |
$1,688.61
|
| Rate for Payer: Anthem Medicaid |
$754.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,710.54
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$1,820.19
|
| Rate for Payer: First Health Commercial |
$2,083.35
|
| Rate for Payer: Humana Commercial |
$1,864.05
|
| Rate for Payer: Humana KY Medicaid |
$754.17
|
| Rate for Payer: Kentucky WC Medicaid |
$761.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,798.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,618.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$769.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,929.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,644.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,907.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.17
|
| Rate for Payer: PHCS Commercial |
$2,105.28
|
| Rate for Payer: United Healthcare All Payer |
$1,929.84
|
|
|
RETROBUTTON LONG 15MM
|
Facility
|
IP
|
$2,193.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.90 |
| Max. Negotiated Rate |
$2,105.28 |
| Rate for Payer: Aetna Commercial |
$1,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,710.54
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$1,820.19
|
| Rate for Payer: First Health Commercial |
$2,083.35
|
| Rate for Payer: Humana Commercial |
$1,864.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,798.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,618.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,929.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,644.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,907.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.17
|
| Rate for Payer: PHCS Commercial |
$2,105.28
|
| Rate for Payer: United Healthcare All Payer |
$1,929.84
|
|
|
RETROBUTTON LONG 20MM
|
Facility
|
OP
|
$2,193.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.90 |
| Max. Negotiated Rate |
$2,105.28 |
| Rate for Payer: Aetna Commercial |
$1,688.61
|
| Rate for Payer: Anthem Medicaid |
$754.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,710.54
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$1,820.19
|
| Rate for Payer: First Health Commercial |
$2,083.35
|
| Rate for Payer: Humana Commercial |
$1,864.05
|
| Rate for Payer: Humana KY Medicaid |
$754.17
|
| Rate for Payer: Kentucky WC Medicaid |
$761.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,798.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,618.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$769.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,929.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,644.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,907.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.17
|
| Rate for Payer: PHCS Commercial |
$2,105.28
|
| Rate for Payer: United Healthcare All Payer |
$1,929.84
|
|
|
RETROBUTTON LONG 20MM
|
Facility
|
IP
|
$2,193.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.90 |
| Max. Negotiated Rate |
$2,105.28 |
| Rate for Payer: Aetna Commercial |
$1,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,710.54
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$1,820.19
|
| Rate for Payer: First Health Commercial |
$2,083.35
|
| Rate for Payer: Humana Commercial |
$1,864.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,798.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,618.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,929.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,644.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,907.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.17
|
| Rate for Payer: PHCS Commercial |
$2,105.28
|
| Rate for Payer: United Healthcare All Payer |
$1,929.84
|
|
|
RETROBUTTON LONG 25MM
|
Facility
|
IP
|
$2,193.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.90 |
| Max. Negotiated Rate |
$2,105.28 |
| Rate for Payer: Aetna Commercial |
$1,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,710.54
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$1,820.19
|
| Rate for Payer: First Health Commercial |
$2,083.35
|
| Rate for Payer: Humana Commercial |
$1,864.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,798.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,618.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,929.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,644.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,907.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.17
|
| Rate for Payer: PHCS Commercial |
$2,105.28
|
| Rate for Payer: United Healthcare All Payer |
$1,929.84
|
|
|
RETROBUTTON LONG 25MM
|
Facility
|
OP
|
$2,193.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.90 |
| Max. Negotiated Rate |
$2,105.28 |
| Rate for Payer: Aetna Commercial |
$1,688.61
|
| Rate for Payer: Anthem Medicaid |
$754.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,710.54
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$1,820.19
|
| Rate for Payer: First Health Commercial |
$2,083.35
|
| Rate for Payer: Humana Commercial |
$1,864.05
|
| Rate for Payer: Humana KY Medicaid |
$754.17
|
| Rate for Payer: Kentucky WC Medicaid |
$761.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,798.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,618.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$769.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,929.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,644.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,907.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.17
|
| Rate for Payer: PHCS Commercial |
$2,105.28
|
| Rate for Payer: United Healthcare All Payer |
$1,929.84
|
|
|
RETROBUTTON XL
|
Facility
|
IP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
RETROBUTTON XL
|
Facility
|
OP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem Medicaid |
$1,029.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Humana KY Medicaid |
$1,029.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,050.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
RETROCUTTER 10.5MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 10.5MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 10MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 10MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 11MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 11MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 12MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 12MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 5.5MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
