|
RADIO PHARM OF TUMOR
|
Facility
|
IP
|
$3,832.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
34000116
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$498.16 |
| Max. Negotiated Rate |
$3,678.72 |
| Rate for Payer: Aetna Commercial |
$2,950.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,988.96
|
| Rate for Payer: Cash Price |
$1,916.00
|
| Rate for Payer: Cigna Commercial |
$3,180.56
|
| Rate for Payer: First Health Commercial |
$3,640.40
|
| Rate for Payer: Humana Commercial |
$3,257.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,142.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,828.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,149.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,372.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,874.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$766.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$498.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,187.92
|
| Rate for Payer: PHCS Commercial |
$3,678.72
|
| Rate for Payer: United Healthcare All Payer |
$3,372.16
|
|
|
RADIO PHARM OF TUMOR
|
Professional
|
Both
|
$3,832.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
34000116
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$3,832.00 |
| Rate for Payer: Aetna Commercial |
$833.66
|
| Rate for Payer: Anthem Medicaid |
$492.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,832.00
|
| Rate for Payer: Cash Price |
$1,916.00
|
| Rate for Payer: Cash Price |
$1,916.00
|
| Rate for Payer: Cigna Commercial |
$742.07
|
| Rate for Payer: Healthspan PPO |
$833.23
|
| Rate for Payer: Humana Medicaid |
$492.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$502.47
|
| Rate for Payer: Molina Healthcare Passport |
$492.62
|
| Rate for Payer: Multiplan PHCS |
$2,299.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,682.40
|
| Rate for Payer: UHCCP Medicaid |
$1,341.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.55
|
|
|
RADIO PHARM OF TUMOR(P
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
340P0116
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$833.66 |
| Rate for Payer: Aetna Commercial |
$833.66
|
| Rate for Payer: Anthem Medicaid |
$492.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$742.07
|
| Rate for Payer: Healthspan PPO |
$833.23
|
| Rate for Payer: Humana Medicaid |
$492.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$502.47
|
| Rate for Payer: Molina Healthcare Passport |
$492.62
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.00
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.55
|
|
|
RADIO PHARM OF TUMOR(T
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
340T0116
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,651.20 |
| Rate for Payer: Aetna Commercial |
$1,324.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,427.60
|
| Rate for Payer: First Health Commercial |
$1,634.00
|
| Rate for Payer: Humana Commercial |
$1,462.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.20
|
| Rate for Payer: PHCS Commercial |
$1,651.20
|
| Rate for Payer: United Healthcare All Payer |
$1,513.60
|
|
|
RADIO PHARM OF TUMOR(T
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
340T0116
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,719.09 |
| Rate for Payer: Aetna Commercial |
$1,324.40
|
| Rate for Payer: Anthem Medicaid |
$591.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,427.60
|
| Rate for Payer: First Health Commercial |
$1,634.00
|
| Rate for Payer: Humana Commercial |
$1,462.00
|
| Rate for Payer: Humana KY Medicaid |
$591.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$597.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$603.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.20
|
| Rate for Payer: PHCS Commercial |
$1,651.20
|
| Rate for Payer: United Healthcare All Payer |
$1,513.60
|
|
|
RADIOPHARM THERAPY ADMIN
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
34000045
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$138.97 |
| Max. Negotiated Rate |
$1,026.24 |
| Rate for Payer: Aetna Commercial |
$823.13
|
| Rate for Payer: Anthem Medicaid |
$367.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$215.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$833.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$301.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$290.44
|
| Rate for Payer: Cash Price |
$534.50
|
| Rate for Payer: Cash Price |
$534.50
|
| Rate for Payer: Cigna Commercial |
$887.27
|
| Rate for Payer: First Health Commercial |
$1,015.55
|
| Rate for Payer: Humana Commercial |
$908.65
|
| Rate for Payer: Humana KY Medicaid |
$367.63
|
| Rate for Payer: Humana Medicare Advantage |
$215.14
|
| Rate for Payer: Kentucky WC Medicaid |
$371.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$876.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$940.72
|
| Rate for Payer: Ohio Health Group HMO |
$801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.39
|
| Rate for Payer: PHCS Commercial |
$1,026.24
|
| Rate for Payer: United Healthcare All Payer |
$940.72
|
|
|
RADIOPHARM THERAPY ADMIN
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
34000045
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$138.97 |
| Max. Negotiated Rate |
$1,026.24 |
| Rate for Payer: Aetna Commercial |
$823.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$833.82
|
| Rate for Payer: Cash Price |
$534.50
|
| Rate for Payer: Cigna Commercial |
$887.27
|
| Rate for Payer: First Health Commercial |
$1,015.55
|
| Rate for Payer: Humana Commercial |
$908.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$876.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$940.72
|
| Rate for Payer: Ohio Health Group HMO |
$801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.39
|
| Rate for Payer: PHCS Commercial |
$1,026.24
|
| Rate for Payer: United Healthcare All Payer |
$940.72
|
|
|
RADIOPHARM THERAPY ADMIN
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
34000045
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$114.79 |
| Max. Negotiated Rate |
$1,069.00 |
| Rate for Payer: Aetna Commercial |
$268.51
|
| Rate for Payer: Anthem Medicaid |
$147.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,069.00
|
| Rate for Payer: Cash Price |
$534.50
|
| Rate for Payer: Cash Price |
$534.50
|
| Rate for Payer: Cigna Commercial |
$280.69
|
| Rate for Payer: Healthspan PPO |
$268.37
|
| Rate for Payer: Humana Medicaid |
$147.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$150.76
|
| Rate for Payer: Molina Healthcare Passport |
$147.80
|
| Rate for Payer: Multiplan PHCS |
$641.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$748.30
|
| Rate for Payer: UHCCP Medicaid |
$374.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.28
|
|
|
RADIOPHARM THERAPY ADMIN(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
340P0045
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$114.79 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$268.51
|
| Rate for Payer: Anthem Medicaid |
$147.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$280.69
|
| Rate for Payer: Healthspan PPO |
$268.37
|
| Rate for Payer: Humana Medicaid |
$147.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$150.76
|
| Rate for Payer: Molina Healthcare Passport |
$147.80
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.28
|
|
|
RADIOPHARM THERAPY ADMIN(T
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
340T0045
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$93.47 |
| Max. Negotiated Rate |
$690.24 |
| Rate for Payer: Aetna Commercial |
$553.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$560.82
|
| Rate for Payer: Cash Price |
$359.50
|
| Rate for Payer: Cigna Commercial |
$596.77
|
| Rate for Payer: First Health Commercial |
$683.05
|
| Rate for Payer: Humana Commercial |
$611.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$589.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$530.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$632.72
|
| Rate for Payer: Ohio Health Group HMO |
$539.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.89
|
| Rate for Payer: PHCS Commercial |
$690.24
|
| Rate for Payer: United Healthcare All Payer |
$632.72
|
|
|
RADIOPHARM THERAPY ADMIN(T
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
340T0045
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$93.47 |
| Max. Negotiated Rate |
$690.24 |
| Rate for Payer: Aetna Commercial |
$553.63
|
| Rate for Payer: Anthem Medicaid |
$247.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$215.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$560.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$301.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$290.44
|
| Rate for Payer: Cash Price |
$359.50
|
| Rate for Payer: Cash Price |
$359.50
|
| Rate for Payer: Cigna Commercial |
$596.77
|
| Rate for Payer: First Health Commercial |
$683.05
|
| Rate for Payer: Humana Commercial |
$611.15
|
| Rate for Payer: Humana KY Medicaid |
$247.26
|
| Rate for Payer: Humana Medicare Advantage |
$215.14
|
| Rate for Payer: Kentucky WC Medicaid |
$249.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$589.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$530.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$252.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$632.72
|
| Rate for Payer: Ohio Health Group HMO |
$539.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.89
|
| Rate for Payer: PHCS Commercial |
$690.24
|
| Rate for Payer: United Healthcare All Payer |
$632.72
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$31,484.56
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$21,364.52 |
| Max. Negotiated Rate |
$31,484.56 |
| Rate for Payer: Anthem Medicaid |
$21,364.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22,488.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31,484.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$30,360.11
|
| Rate for Payer: Humana KY Medicaid |
$21,364.52
|
| Rate for Payer: Humana Medicare Advantage |
$22,488.97
|
| Rate for Payer: Kentucky WC Medicaid |
$21,578.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,986.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,791.81
|
|
|
RAD RESECT HAND TUMOR 3 CM/>
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 26118
|
| Hospital Charge Code |
76100671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$767.50 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,629.59
|
| Rate for Payer: Anthem Medicaid |
$767.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,857.83
|
| Rate for Payer: Healthspan PPO |
$1,162.81
|
| Rate for Payer: Humana Medicaid |
$767.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,360.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$782.85
|
| Rate for Payer: Molina Healthcare Passport |
$767.50
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$775.18
|
|
|
RAD RESECT HAND TUMOR 3 CM/>
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 26118
|
| Hospital Charge Code |
76100671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
RAD RESECT HAND TUMOR 3 CM/>
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 26118
|
| Hospital Charge Code |
76100671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
RAD RESECT HAND TUMOR 3 CM/(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 26118
|
| Hospital Charge Code |
761P0671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$767.50 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,629.59
|
| Rate for Payer: Anthem Medicaid |
$767.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,857.83
|
| Rate for Payer: Healthspan PPO |
$1,162.81
|
| Rate for Payer: Humana Medicaid |
$767.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,360.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$782.85
|
| Rate for Payer: Molina Healthcare Passport |
$767.50
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$775.18
|
|
|
RA FACTOR QUAL (RHEUMATOID)
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
30001096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem Medicaid |
$6.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.14
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Humana KY Medicaid |
$6.14
|
| Rate for Payer: Humana Medicare Advantage |
$6.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.24
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
RA FACTOR QUAL (RHEUMATOID)
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
30001096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.24
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
RALENZA (ZANIMIVIR) 5MG INHAL
|
Facility
|
IP
|
$14.70
|
|
|
Service Code
|
NDC 173068101
|
| Hospital Charge Code |
25001287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$14.11 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.47
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: Cigna Commercial |
$12.20
|
| Rate for Payer: First Health Commercial |
$13.96
|
| Rate for Payer: Humana Commercial |
$12.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.94
|
| Rate for Payer: Ohio Health Group HMO |
$11.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.56
|
| Rate for Payer: PHCS Commercial |
$14.11
|
| Rate for Payer: United Healthcare All Payer |
$12.94
|
|
|
RALENZA (ZANIMIVIR) 5MG INHAL
|
Facility
|
OP
|
$14.70
|
|
|
Service Code
|
NDC 173068101
|
| Hospital Charge Code |
25001287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$14.11 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: Anthem Medicaid |
$5.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.47
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: Cigna Commercial |
$12.20
|
| Rate for Payer: First Health Commercial |
$13.96
|
| Rate for Payer: Humana Commercial |
$12.50
|
| Rate for Payer: Humana KY Medicaid |
$5.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.94
|
| Rate for Payer: Ohio Health Group HMO |
$11.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.56
|
| Rate for Payer: PHCS Commercial |
$14.11
|
| Rate for Payer: United Healthcare All Payer |
$12.94
|
|
|
RALMETEON 8MG TABLET
|
Facility
|
IP
|
$29.97
|
|
|
Service Code
|
NDC 64764080510
|
| Hospital Charge Code |
25001288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$28.77 |
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.38
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: First Health Commercial |
$28.47
|
| Rate for Payer: Humana Commercial |
$25.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.37
|
| Rate for Payer: Ohio Health Group HMO |
$22.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.29
|
| Rate for Payer: PHCS Commercial |
$28.77
|
| Rate for Payer: United Healthcare All Payer |
$26.37
|
|
|
RALMETEON 8MG TABLET
|
Facility
|
OP
|
$29.97
|
|
|
Service Code
|
NDC 64764080510
|
| Hospital Charge Code |
25001288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$28.77 |
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Anthem Medicaid |
$10.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.38
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: First Health Commercial |
$28.47
|
| Rate for Payer: Humana Commercial |
$25.47
|
| Rate for Payer: Humana KY Medicaid |
$10.31
|
| Rate for Payer: Kentucky WC Medicaid |
$10.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.37
|
| Rate for Payer: Ohio Health Group HMO |
$22.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.29
|
| Rate for Payer: PHCS Commercial |
$28.77
|
| Rate for Payer: United Healthcare All Payer |
$26.37
|
|
|
RANEXA (RANOLAZINE) 500MG
|
Facility
|
OP
|
$9.58
|
|
|
Service Code
|
NDC 50268072215
|
| Hospital Charge Code |
25001289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Anthem Medicaid |
$3.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.47
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cigna Commercial |
$7.95
|
| Rate for Payer: First Health Commercial |
$9.10
|
| Rate for Payer: Humana Commercial |
$8.14
|
| Rate for Payer: Humana KY Medicaid |
$3.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.43
|
| Rate for Payer: Ohio Health Group HMO |
$7.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$9.20
|
| Rate for Payer: United Healthcare All Payer |
$8.43
|
| Rate for Payer: Aetna Commercial |
$7.38
|
|
|
RANEXA (RANOLAZINE) 500MG
|
Facility
|
IP
|
$9.58
|
|
|
Service Code
|
NDC 50268072215
|
| Hospital Charge Code |
25001289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$7.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.47
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cigna Commercial |
$7.95
|
| Rate for Payer: First Health Commercial |
$9.10
|
| Rate for Payer: Humana Commercial |
$8.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.43
|
| Rate for Payer: Ohio Health Group HMO |
$7.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$9.20
|
| Rate for Payer: United Healthcare All Payer |
$8.43
|
|
|
RANGER GLOBAL DBC OTW 4*60*135
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
