|
ROD TO ROD COUPLING 8/8MM
|
Facility
|
IP
|
$4,445.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.50 |
| Max. Negotiated Rate |
$4,267.20 |
| Rate for Payer: Aetna Commercial |
$3,422.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,467.10
|
| Rate for Payer: Cash Price |
$2,222.50
|
| Rate for Payer: Cigna Commercial |
$3,689.35
|
| Rate for Payer: First Health Commercial |
$4,222.75
|
| Rate for Payer: Humana Commercial |
$3,778.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,644.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,280.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,911.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,333.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,556.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,867.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.05
|
| Rate for Payer: PHCS Commercial |
$4,267.20
|
| Rate for Payer: United Healthcare All Payer |
$3,911.60
|
|
|
ROGER CLIP-ON MIC
|
Professional
|
Both
|
$640.00
|
|
| Hospital Charge Code |
22200664
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
|
|
ROLLER MESSAGE TABLE NEURO
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 97039
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.84
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.32
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
ROLLER MESSAGE TABLE NEURO
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 97039
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem Medicaid |
$44.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.84
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Humana KY Medicaid |
$44.02
|
| Rate for Payer: Kentucky WC Medicaid |
$44.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.32
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
ROMAZICON(FLUMAZENIL) .5MG/5ML
|
Facility
|
IP
|
$113.50
|
|
|
Service Code
|
NDC 36000014801
|
| Hospital Charge Code |
25003422
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$108.96 |
| Rate for Payer: Aetna Commercial |
$87.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.53
|
| Rate for Payer: Cash Price |
$56.75
|
| Rate for Payer: Cigna Commercial |
$94.20
|
| Rate for Payer: First Health Commercial |
$107.83
|
| Rate for Payer: Humana Commercial |
$96.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.88
|
| Rate for Payer: Ohio Health Group HMO |
$85.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.31
|
| Rate for Payer: PHCS Commercial |
$108.96
|
| Rate for Payer: United Healthcare All Payer |
$99.88
|
|
|
ROMAZICON(FLUMAZENIL) .5MG/5ML
|
Facility
|
OP
|
$113.50
|
|
|
Service Code
|
NDC 36000014801
|
| Hospital Charge Code |
25003422
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$108.96 |
| Rate for Payer: Aetna Commercial |
$87.39
|
| Rate for Payer: Anthem Medicaid |
$39.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.53
|
| Rate for Payer: Cash Price |
$56.75
|
| Rate for Payer: Cigna Commercial |
$94.20
|
| Rate for Payer: First Health Commercial |
$107.83
|
| Rate for Payer: Humana Commercial |
$96.47
|
| Rate for Payer: Humana KY Medicaid |
$39.03
|
| Rate for Payer: Kentucky WC Medicaid |
$39.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.88
|
| Rate for Payer: Ohio Health Group HMO |
$85.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.31
|
| Rate for Payer: PHCS Commercial |
$108.96
|
| Rate for Payer: United Healthcare All Payer |
$99.88
|
|
|
RONDEC(CARBIN/PSEUDOEPH)SY 5ML
|
Facility
|
IP
|
$4.83
|
|
|
Service Code
|
NDC 16477010116
|
| Hospital Charge Code |
25001346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.77
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna Commercial |
$4.01
|
| Rate for Payer: First Health Commercial |
$4.59
|
| Rate for Payer: Humana Commercial |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.25
|
| Rate for Payer: Ohio Health Group HMO |
$3.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.33
|
| Rate for Payer: PHCS Commercial |
$4.64
|
| Rate for Payer: United Healthcare All Payer |
$4.25
|
|
|
RONDEC(CARBIN/PSEUDOEPH)SY 5ML
|
Facility
|
OP
|
$4.83
|
|
|
Service Code
|
NDC 16477010116
|
| Hospital Charge Code |
25001346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Anthem Medicaid |
$1.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.77
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna Commercial |
$4.01
|
| Rate for Payer: First Health Commercial |
$4.59
|
| Rate for Payer: Humana Commercial |
$4.11
|
| Rate for Payer: Humana KY Medicaid |
$1.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.25
|
| Rate for Payer: Ohio Health Group HMO |
$3.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.33
|
| Rate for Payer: PHCS Commercial |
$4.64
|
| Rate for Payer: United Healthcare All Payer |
$4.25
|
|
|
ROPIVACAINE 0.2% 1MG/ML SDV
|
Facility
|
OP
|
$8.01
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
636T0201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.69 |
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.25
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: First Health Commercial |
$7.61
|
| Rate for Payer: Humana Commercial |
$6.81
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.05
|
| Rate for Payer: Ohio Health Group HMO |
$6.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.53
|
| Rate for Payer: PHCS Commercial |
$7.69
|
| Rate for Payer: United Healthcare All Payer |
$7.05
|
|
|
ROPIVACAINE 0.2% 1MG/ML SDV
|
Facility
|
IP
|
$8.01
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
636T0201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.69 |
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.25
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: First Health Commercial |
$7.61
|
| Rate for Payer: Humana Commercial |
$6.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.05
|
| Rate for Payer: Ohio Health Group HMO |
$6.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.53
|
| Rate for Payer: PHCS Commercial |
$7.69
|
| Rate for Payer: United Healthcare All Payer |
$7.05
|
|
|
ROPIVACAINE 0.2% 1MG/MLSDV
|
Facility
|
OP
|
$8.01
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.69 |
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.25
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: First Health Commercial |
$7.61
|
| Rate for Payer: Humana Commercial |
$6.81
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.05
|
| Rate for Payer: Ohio Health Group HMO |
$6.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.53
|
| Rate for Payer: PHCS Commercial |
$7.69
|
| Rate for Payer: United Healthcare All Payer |
$7.05
|
|
|
ROPIVACAINE 0.2% 1MG/MLSDV
|
Facility
|
IP
|
$8.01
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.69 |
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.25
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: First Health Commercial |
$7.61
|
| Rate for Payer: Humana Commercial |
$6.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.05
|
| Rate for Payer: Ohio Health Group HMO |
$6.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.53
|
| Rate for Payer: PHCS Commercial |
$7.69
|
| Rate for Payer: United Healthcare All Payer |
$7.05
|
|
|
ROPIVACAINE 0.2% 1MG/MLSDV
|
Professional
|
Both
|
$8.01
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna Commercial |
$0.11
|
| Rate for Payer: Ambetter Exchange |
$0.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.07
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Healthspan PPO |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.06
|
| Rate for Payer: Multiplan PHCS |
$4.81
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.08
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.06
|
|
|
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 |
$24.03 |
| 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 |
$64.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.26
|
| Rate for Payer: PHCS Commercial |
$76.89
|
| Rate for Payer: United Healthcare All Payer |
$70.48
|
|
|
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 |
$24.03 |
| 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 |
$64.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.26
|
| 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 |
$103.88 |
| Max. Negotiated Rate |
$332.40 |
| Rate for Payer: Aetna Commercial |
$266.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$270.07
|
| 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 |
$283.93
|
| 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 |
$277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$301.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.91
|
| 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 |
$103.88 |
| 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 |
$270.07
|
| 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 |
$283.93
|
| 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 |
$277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$301.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.91
|
| Rate for Payer: PHCS Commercial |
$332.40
|
| Rate for Payer: United Healthcare All Payer |
$304.70
|
|
|
ROPIVACAINE 0.5% 1MG 5MG/MLSDV
|
Facility
|
OP
|
$25.18
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$24.17 |
| Rate for Payer: Aetna Commercial |
$19.39
|
| Rate for Payer: Anthem Medicaid |
$8.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.64
|
| Rate for Payer: Cash Price |
$12.59
|
| Rate for Payer: Cigna Commercial |
$20.90
|
| Rate for Payer: First Health Commercial |
$23.92
|
| Rate for Payer: Humana Commercial |
$21.40
|
| Rate for Payer: Humana KY Medicaid |
$8.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.16
|
| Rate for Payer: Ohio Health Group HMO |
$18.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.37
|
| Rate for Payer: PHCS Commercial |
$24.17
|
| Rate for Payer: United Healthcare All Payer |
$22.16
|
|
|
ROPIVACAINE 0.5% 1MG 5MG/MLSDV
|
Facility
|
OP
|
$25.18
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
636T0202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$24.17 |
| Rate for Payer: Aetna Commercial |
$19.39
|
| Rate for Payer: Anthem Medicaid |
$8.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.64
|
| Rate for Payer: Cash Price |
$12.59
|
| Rate for Payer: Cigna Commercial |
$20.90
|
| Rate for Payer: First Health Commercial |
$23.92
|
| Rate for Payer: Humana Commercial |
$21.40
|
| Rate for Payer: Humana KY Medicaid |
$8.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.16
|
| Rate for Payer: Ohio Health Group HMO |
$18.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.37
|
| Rate for Payer: PHCS Commercial |
$24.17
|
| Rate for Payer: United Healthcare All Payer |
$22.16
|
|
|
ROPIVACAINE 0.5% 1MG 5MG/MLSDV
|
Facility
|
IP
|
$25.18
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
636T0202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$24.17 |
| Rate for Payer: Aetna Commercial |
$19.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.64
|
| Rate for Payer: Cash Price |
$12.59
|
| Rate for Payer: Cigna Commercial |
$20.90
|
| Rate for Payer: First Health Commercial |
$23.92
|
| Rate for Payer: Humana Commercial |
$21.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.16
|
| Rate for Payer: Ohio Health Group HMO |
$18.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.37
|
| Rate for Payer: PHCS Commercial |
$24.17
|
| Rate for Payer: United Healthcare All Payer |
$22.16
|
|
|
ROPIVACAINE 0.5% 1MG 5MG/MLSDV
|
Professional
|
Both
|
$25.18
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna Commercial |
$0.11
|
| Rate for Payer: Ambetter Exchange |
$0.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.07
|
| Rate for Payer: Cash Price |
$12.59
|
| Rate for Payer: Cash Price |
$12.59
|
| Rate for Payer: Healthspan PPO |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.06
|
| Rate for Payer: Multiplan PHCS |
$15.11
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.08
|
| Rate for Payer: UHCCP Medicaid |
$8.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.06
|
|
|
ROPIVACAINE 0.5% 1MG 5MG/MLSDV
|
Facility
|
IP
|
$25.18
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
63600202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$24.17 |
| Rate for Payer: Aetna Commercial |
$19.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.64
|
| Rate for Payer: Cash Price |
$12.59
|
| Rate for Payer: Cigna Commercial |
$20.90
|
| Rate for Payer: First Health Commercial |
$23.92
|
| Rate for Payer: Humana Commercial |
$21.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.16
|
| Rate for Payer: Ohio Health Group HMO |
$18.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.37
|
| Rate for Payer: PHCS Commercial |
$24.17
|
| Rate for Payer: United Healthcare All Payer |
$22.16
|
|
|
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 |
$23.60 |
| 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 |
$62.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.29
|
| Rate for Payer: PHCS Commercial |
$75.53
|
| Rate for Payer: United Healthcare All Payer |
$69.24
|
|
|
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 |
$23.60 |
| 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 |
$62.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.29
|
| Rate for Payer: PHCS Commercial |
$75.53
|
| Rate for Payer: United Healthcare All Payer |
$69.24
|
|
|
ROTALINK BURR 1.75MM
|
Facility
|
IP
|
$10,026.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,007.88 |
| Max. Negotiated Rate |
$9,625.20 |
| Rate for Payer: Aetna Commercial |
$7,720.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,820.48
|
| Rate for Payer: Cash Price |
$5,013.12
|
| Rate for Payer: Cigna Commercial |
$8,321.79
|
| Rate for Payer: First Health Commercial |
$9,524.94
|
| Rate for Payer: Humana Commercial |
$8,522.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,221.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,519.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,021.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,722.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,918.11
|
| Rate for Payer: PHCS Commercial |
$9,625.20
|
| Rate for Payer: United Healthcare All Payer |
$8,823.10
|
|
