|
RIGHT HEART CATH
|
Facility
|
IP
|
$11,836.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
48100062
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,550.80 |
| Max. Negotiated Rate |
$11,362.56 |
| Rate for Payer: Aetna Commercial |
$9,113.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,232.08
|
| Rate for Payer: Cash Price |
$5,918.00
|
| Rate for Payer: Cigna Commercial |
$9,823.88
|
| Rate for Payer: First Health Commercial |
$11,244.20
|
| Rate for Payer: Humana Commercial |
$10,060.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,705.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,734.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,550.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,415.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,877.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,468.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,297.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,166.84
|
| Rate for Payer: PHCS Commercial |
$11,362.56
|
| Rate for Payer: United Healthcare All Payer |
$10,415.68
|
|
|
RIGHT HEART CATH
|
Facility
|
IP
|
$12,255.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
76102475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,676.50 |
| Max. Negotiated Rate |
$11,764.80 |
| Rate for Payer: Aetna Commercial |
$9,436.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,558.90
|
| Rate for Payer: Cash Price |
$6,127.50
|
| Rate for Payer: Cigna Commercial |
$10,171.65
|
| Rate for Payer: First Health Commercial |
$11,642.25
|
| Rate for Payer: Humana Commercial |
$10,416.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,049.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,044.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,676.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,784.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,661.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,455.95
|
| Rate for Payer: PHCS Commercial |
$11,764.80
|
| Rate for Payer: United Healthcare All Payer |
$10,784.40
|
|
|
RIGHT HEART CATH
|
Facility
|
OP
|
$12,255.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
76102475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$11,764.80 |
| Rate for Payer: Aetna Commercial |
$9,436.35
|
| Rate for Payer: Anthem Medicaid |
$4,214.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,558.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$6,127.50
|
| Rate for Payer: Cash Price |
$6,127.50
|
| Rate for Payer: Cigna Commercial |
$10,171.65
|
| Rate for Payer: First Health Commercial |
$11,642.25
|
| Rate for Payer: Humana Commercial |
$10,416.75
|
| Rate for Payer: Humana KY Medicaid |
$4,214.49
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,257.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,049.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,044.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,299.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,784.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,661.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,455.95
|
| Rate for Payer: PHCS Commercial |
$11,764.80
|
| Rate for Payer: United Healthcare All Payer |
$10,784.40
|
|
|
RIGHT HEART CATH
|
Professional
|
Both
|
$12,255.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
76102475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.18 |
| Max. Negotiated Rate |
$7,353.00 |
| Rate for Payer: Aetna Commercial |
$1,189.33
|
| Rate for Payer: Ambetter Exchange |
$730.96
|
| Rate for Payer: Anthem Medicaid |
$666.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$730.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$730.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.15
|
| Rate for Payer: Cash Price |
$6,127.50
|
| Rate for Payer: Cash Price |
$6,127.50
|
| Rate for Payer: Cigna Commercial |
$1,304.97
|
| Rate for Payer: Healthspan PPO |
$883.92
|
| Rate for Payer: Humana Medicaid |
$666.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$730.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$680.01
|
| Rate for Payer: Molina Healthcare Passport |
$666.68
|
| Rate for Payer: Multiplan PHCS |
$7,353.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$950.25
|
| Rate for Payer: UHCCP Medicaid |
$4,289.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$673.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$730.96
|
|
|
RIGHT HEART CATH
|
Facility
|
OP
|
$11,836.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
48100062
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$11,362.56 |
| Rate for Payer: Aetna Commercial |
$9,113.72
|
| Rate for Payer: Anthem Medicaid |
$4,070.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,232.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$5,918.00
|
| Rate for Payer: Cash Price |
$5,918.00
|
| Rate for Payer: Cigna Commercial |
$9,823.88
|
| Rate for Payer: First Health Commercial |
$11,244.20
|
| Rate for Payer: Humana Commercial |
$10,060.60
|
| Rate for Payer: Humana KY Medicaid |
$4,070.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,111.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,705.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,734.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,152.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,415.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,877.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,468.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,297.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,166.84
|
| Rate for Payer: PHCS Commercial |
$11,362.56
|
| Rate for Payer: United Healthcare All Payer |
$10,415.68
|
|
|
RIGHT HEART CATH(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
761P2475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$1,304.97 |
| Rate for Payer: Aetna Commercial |
$1,189.33
|
| Rate for Payer: Ambetter Exchange |
$730.96
|
| Rate for Payer: Anthem Medicaid |
$666.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$730.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$730.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.15
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$1,304.97
|
| Rate for Payer: Healthspan PPO |
$883.92
|
| Rate for Payer: Humana Medicaid |
$666.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$730.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$680.01
|
| Rate for Payer: Molina Healthcare Passport |
$666.68
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$950.25
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$673.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$730.96
|
|
|
RIGHT HEART CATH(T
|
Facility
|
IP
|
$11,905.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
761T2475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,571.50 |
| Max. Negotiated Rate |
$11,428.80 |
| Rate for Payer: Aetna Commercial |
$9,166.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,285.90
|
| Rate for Payer: Cash Price |
$5,952.50
|
| Rate for Payer: Cigna Commercial |
$9,881.15
|
| Rate for Payer: First Health Commercial |
$11,309.75
|
| Rate for Payer: Humana Commercial |
$10,119.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,762.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,785.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,571.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,476.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,928.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,524.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,357.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,214.45
|
| Rate for Payer: PHCS Commercial |
$11,428.80
|
| Rate for Payer: United Healthcare All Payer |
$10,476.40
|
|
|
RIGHT HEART CATH(T
|
Facility
|
OP
|
$11,905.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
761T2475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$11,428.80 |
| Rate for Payer: Aetna Commercial |
$9,166.85
|
| Rate for Payer: Anthem Medicaid |
$4,094.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,285.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$5,952.50
|
| Rate for Payer: Cash Price |
$5,952.50
|
| Rate for Payer: Cigna Commercial |
$9,881.15
|
| Rate for Payer: First Health Commercial |
$11,309.75
|
| Rate for Payer: Humana Commercial |
$10,119.25
|
| Rate for Payer: Humana KY Medicaid |
$4,094.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,135.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,762.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,785.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,176.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,476.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,928.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,524.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,357.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,214.45
|
| Rate for Payer: PHCS Commercial |
$11,428.80
|
| Rate for Payer: United Healthcare All Payer |
$10,476.40
|
|
|
RILUTEK (RILUZOLE)50MG TAB
|
Facility
|
IP
|
$9.32
|
|
|
Service Code
|
NDC 68462038160
|
| Hospital Charge Code |
25001330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.27
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.85
|
| Rate for Payer: Humana Commercial |
$7.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.20
|
| Rate for Payer: Ohio Health Group HMO |
$6.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.43
|
| Rate for Payer: PHCS Commercial |
$8.95
|
| Rate for Payer: United Healthcare All Payer |
$8.20
|
|
|
RILUTEK (RILUZOLE)50MG TAB
|
Facility
|
OP
|
$9.32
|
|
|
Service Code
|
NDC 68462038160
|
| Hospital Charge Code |
25001330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem Medicaid |
$3.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.27
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.85
|
| Rate for Payer: Humana Commercial |
$7.92
|
| Rate for Payer: Humana KY Medicaid |
$3.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.20
|
| Rate for Payer: Ohio Health Group HMO |
$6.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.43
|
| Rate for Payer: PHCS Commercial |
$8.95
|
| Rate for Payer: United Healthcare All Payer |
$8.20
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
OP
|
$3,977.03
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
25002036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$742.90 |
| Max. Negotiated Rate |
$3,817.95 |
| Rate for Payer: Aetna Commercial |
$3,062.31
|
| Rate for Payer: Anthem Medicaid |
$1,367.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$742.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,102.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,040.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,002.91
|
| Rate for Payer: Cash Price |
$1,988.52
|
| Rate for Payer: Cash Price |
$1,988.52
|
| Rate for Payer: Cigna Commercial |
$3,300.93
|
| Rate for Payer: First Health Commercial |
$3,778.18
|
| Rate for Payer: Humana Commercial |
$3,380.48
|
| Rate for Payer: Humana KY Medicaid |
$1,367.70
|
| Rate for Payer: Humana Medicare Advantage |
$742.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,381.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,261.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,935.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$891.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,395.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,181.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,460.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,744.15
|
| Rate for Payer: PHCS Commercial |
$3,817.95
|
| Rate for Payer: United Healthcare All Payer |
$3,499.79
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
OP
|
$3,977.03
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
636T0032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$742.90 |
| Max. Negotiated Rate |
$3,817.95 |
| Rate for Payer: Aetna Commercial |
$3,062.31
|
| Rate for Payer: Anthem Medicaid |
$1,367.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$742.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,102.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,040.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,002.91
|
| Rate for Payer: Cash Price |
$1,988.52
|
| Rate for Payer: Cash Price |
$1,988.52
|
| Rate for Payer: Cigna Commercial |
$3,300.93
|
| Rate for Payer: First Health Commercial |
$3,778.18
|
| Rate for Payer: Humana Commercial |
$3,380.48
|
| Rate for Payer: Humana KY Medicaid |
$1,367.70
|
| Rate for Payer: Humana Medicare Advantage |
$742.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,381.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,261.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,935.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$891.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,395.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,181.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,460.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,744.15
|
| Rate for Payer: PHCS Commercial |
$3,817.95
|
| Rate for Payer: United Healthcare All Payer |
$3,499.79
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
OP
|
$3,977.03
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
63600032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$742.90 |
| Max. Negotiated Rate |
$3,817.95 |
| Rate for Payer: Aetna Commercial |
$3,062.31
|
| Rate for Payer: Anthem Medicaid |
$1,367.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$742.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,102.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,040.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,002.91
|
| Rate for Payer: Cash Price |
$1,988.52
|
| Rate for Payer: Cash Price |
$1,988.52
|
| Rate for Payer: Cigna Commercial |
$3,300.93
|
| Rate for Payer: First Health Commercial |
$3,778.18
|
| Rate for Payer: Humana Commercial |
$3,380.48
|
| Rate for Payer: Humana KY Medicaid |
$1,367.70
|
| Rate for Payer: Humana Medicare Advantage |
$742.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,381.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,261.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,935.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$891.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,395.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,181.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,460.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,744.15
|
| Rate for Payer: PHCS Commercial |
$3,817.95
|
| Rate for Payer: United Healthcare All Payer |
$3,499.79
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
IP
|
$3,977.03
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
636T0032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,193.11 |
| Max. Negotiated Rate |
$3,817.95 |
| Rate for Payer: Aetna Commercial |
$3,062.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,102.08
|
| Rate for Payer: Cash Price |
$1,988.52
|
| Rate for Payer: Cigna Commercial |
$3,300.93
|
| Rate for Payer: First Health Commercial |
$3,778.18
|
| Rate for Payer: Humana Commercial |
$3,380.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,261.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,935.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,193.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,181.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,460.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,744.15
|
| Rate for Payer: PHCS Commercial |
$3,817.95
|
| Rate for Payer: United Healthcare All Payer |
$3,499.79
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Professional
|
Both
|
$3,977.03
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
63600032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$742.90 |
| Max. Negotiated Rate |
$2,386.22 |
| Rate for Payer: Aetna Commercial |
$871.47
|
| Rate for Payer: Ambetter Exchange |
$742.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$742.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$742.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$891.48
|
| Rate for Payer: Cash Price |
$1,988.52
|
| Rate for Payer: Cash Price |
$1,988.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$903.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$742.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.90
|
| Rate for Payer: Multiplan PHCS |
$2,386.22
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$965.77
|
| Rate for Payer: UHCCP Medicaid |
$1,391.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$742.90
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
IP
|
$3,977.03
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
63600032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,193.11 |
| Max. Negotiated Rate |
$3,817.95 |
| Rate for Payer: Aetna Commercial |
$3,062.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,102.08
|
| Rate for Payer: Cash Price |
$1,988.52
|
| Rate for Payer: Cigna Commercial |
$3,300.93
|
| Rate for Payer: First Health Commercial |
$3,778.18
|
| Rate for Payer: Humana Commercial |
$3,380.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,261.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,935.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,193.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,181.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,460.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,744.15
|
| Rate for Payer: PHCS Commercial |
$3,817.95
|
| Rate for Payer: United Healthcare All Payer |
$3,499.79
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
IP
|
$3,977.03
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
25002036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,193.11 |
| Max. Negotiated Rate |
$3,817.95 |
| Rate for Payer: Aetna Commercial |
$3,062.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,102.08
|
| Rate for Payer: Cash Price |
$1,988.52
|
| Rate for Payer: Cigna Commercial |
$3,300.93
|
| Rate for Payer: First Health Commercial |
$3,778.18
|
| Rate for Payer: Humana Commercial |
$3,380.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,261.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,935.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,193.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,181.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,460.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,744.15
|
| Rate for Payer: PHCS Commercial |
$3,817.95
|
| Rate for Payer: United Healthcare All Payer |
$3,499.79
|
|
|
RING CONT RECN TRL 50/46 RT
|
Facility
|
OP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem Medicaid |
$1,095.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Humana KY Medicaid |
$1,095.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,106.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,117.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 50/46 RT
|
Facility
|
IP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 56/52 RT
|
Facility
|
OP
|
$3,286.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$985.88 |
| Max. Negotiated Rate |
$3,154.80 |
| Rate for Payer: Aetna Commercial |
$2,530.41
|
| Rate for Payer: Anthem Medicaid |
$1,130.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,563.28
|
| Rate for Payer: Cash Price |
$1,643.12
|
| Rate for Payer: Cigna Commercial |
$2,727.59
|
| Rate for Payer: First Health Commercial |
$3,121.94
|
| Rate for Payer: Humana Commercial |
$2,793.31
|
| Rate for Payer: Humana KY Medicaid |
$1,130.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,141.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,694.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,425.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,152.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,891.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,464.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,629.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,859.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,267.51
|
| Rate for Payer: PHCS Commercial |
$3,154.80
|
| Rate for Payer: United Healthcare All Payer |
$2,891.90
|
|
|
RING CONT RECN TRL 56/52 RT
|
Facility
|
IP
|
$3,286.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$985.88 |
| Max. Negotiated Rate |
$3,154.80 |
| Rate for Payer: Aetna Commercial |
$2,530.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,563.28
|
| Rate for Payer: Cash Price |
$1,643.12
|
| Rate for Payer: Cigna Commercial |
$2,727.59
|
| Rate for Payer: First Health Commercial |
$3,121.94
|
| Rate for Payer: Humana Commercial |
$2,793.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,694.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,425.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,891.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,464.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,629.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,859.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,267.51
|
| Rate for Payer: PHCS Commercial |
$3,154.80
|
| Rate for Payer: United Healthcare All Payer |
$2,891.90
|
|
|
RING CONT RECN TRL 62/58 LT
|
Facility
|
OP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem Medicaid |
$1,095.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Humana KY Medicaid |
$1,095.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,106.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,117.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 62/58 LT
|
Facility
|
IP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 62/58 RT
|
Facility
|
IP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 62/58 RT
|
Facility
|
OP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem Medicaid |
$1,095.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Humana KY Medicaid |
$1,095.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,106.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,117.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
