|
RAPID STREP A POC
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
RAPID STREP A POC
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
RAPID STREP A POC
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$160.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.00
|
| Rate for Payer: UHCCP Medicaid |
$56.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
RAPID STREP A SCREEN PCR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
RAPID STREP A SCREEN PCR
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$160.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.00
|
| Rate for Payer: UHCCP Medicaid |
$56.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
RAPID STREP A SCREEN PCR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
RAPIVAB 200MG/20ML VIAL
|
Facility
|
IP
|
$1,725.85
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
25002314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$224.36 |
| Max. Negotiated Rate |
$1,656.82 |
| Rate for Payer: Aetna Commercial |
$1,328.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,346.16
|
| Rate for Payer: Cash Price |
$862.92
|
| Rate for Payer: Cigna Commercial |
$1,432.46
|
| Rate for Payer: First Health Commercial |
$1,639.56
|
| Rate for Payer: Humana Commercial |
$1,466.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,415.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,273.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,518.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,294.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.01
|
| Rate for Payer: PHCS Commercial |
$1,656.82
|
| Rate for Payer: United Healthcare All Payer |
$1,518.75
|
|
|
RAPIVAB 200MG/20ML VIAL
|
Facility
|
OP
|
$1,725.85
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
25002314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$1,656.82 |
| Rate for Payer: Aetna Commercial |
$1,328.90
|
| Rate for Payer: Anthem Medicaid |
$593.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,346.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.05
|
| Rate for Payer: Cash Price |
$862.92
|
| Rate for Payer: Cash Price |
$862.92
|
| Rate for Payer: Cigna Commercial |
$1,432.46
|
| Rate for Payer: First Health Commercial |
$1,639.56
|
| Rate for Payer: Humana Commercial |
$1,466.97
|
| Rate for Payer: Humana KY Medicaid |
$593.52
|
| Rate for Payer: Humana Medicare Advantage |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$599.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,415.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,273.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$605.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,518.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,294.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.01
|
| Rate for Payer: PHCS Commercial |
$1,656.82
|
| Rate for Payer: United Healthcare All Payer |
$1,518.75
|
|
|
RA QUANT
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: Anthem Medicaid |
$5.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.67
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.98
|
| Rate for Payer: First Health Commercial |
$5.70
|
| Rate for Payer: Humana Commercial |
$5.10
|
| Rate for Payer: Humana KY Medicaid |
$5.67
|
| Rate for Payer: Humana Medicare Advantage |
$5.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.28
|
| Rate for Payer: Ohio Health Group HMO |
$4.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.86
|
| Rate for Payer: PHCS Commercial |
$5.76
|
| Rate for Payer: United Healthcare All Payer |
$5.28
|
|
|
RA QUANT
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem Medicaid |
$5.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.67
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Humana KY Medicaid |
$5.67
|
| Rate for Payer: Humana Medicare Advantage |
$5.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
RA QUANT
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$8.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$5.04
|
| Rate for Payer: Healthspan PPO |
$5.95
|
| Rate for Payer: Multiplan PHCS |
$61.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.40
|
| Rate for Payer: UHCCP Medicaid |
$35.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.40
|
|
|
RA QUANT
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.82
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.98
|
| Rate for Payer: First Health Commercial |
$5.70
|
| Rate for Payer: Humana Commercial |
$5.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.28
|
| Rate for Payer: Ohio Health Group HMO |
$4.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.86
|
| Rate for Payer: PHCS Commercial |
$5.76
|
| Rate for Payer: United Healthcare All Payer |
$5.28
|
|
|
RA QUANT
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.91
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
RAZADYNE ER 8 MG CAPSULE
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 65862074430
|
| Hospital Charge Code |
25001292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
| Rate for Payer: Humana Commercial |
$8.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.36
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Payer |
$8.36
|
|
|
RAZADYNE ER 8 MG CAPSULE
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
NDC 65862074430
|
| Hospital Charge Code |
25001292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem Medicaid |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
| Rate for Payer: Humana Commercial |
$8.08
|
| Rate for Payer: Humana KY Medicaid |
$3.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.36
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Payer |
$8.36
|
|
|
RB82 RUBIDIUM
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
HCPCS A9555
|
| Hospital Charge Code |
34000062
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$154.96 |
| Max. Negotiated Rate |
$1,144.32 |
| Rate for Payer: Aetna Commercial |
$917.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$929.76
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cigna Commercial |
$989.36
|
| Rate for Payer: First Health Commercial |
$1,132.40
|
| Rate for Payer: Humana Commercial |
$1,013.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$977.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$879.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,048.96
|
| Rate for Payer: Ohio Health Group HMO |
$894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.52
|
| Rate for Payer: PHCS Commercial |
$1,144.32
|
| Rate for Payer: United Healthcare All Payer |
$1,048.96
|
|
|
RB82 RUBIDIUM
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
HCPCS A9555
|
| Hospital Charge Code |
34000062
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$154.96 |
| Max. Negotiated Rate |
$1,144.32 |
| Rate for Payer: Aetna Commercial |
$917.84
|
| Rate for Payer: Anthem Medicaid |
$409.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$929.76
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cigna Commercial |
$989.36
|
| Rate for Payer: First Health Commercial |
$1,132.40
|
| Rate for Payer: Humana Commercial |
$1,013.20
|
| Rate for Payer: Humana KY Medicaid |
$409.93
|
| Rate for Payer: Kentucky WC Medicaid |
$414.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$977.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$879.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$418.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,048.96
|
| Rate for Payer: Ohio Health Group HMO |
$894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.52
|
| Rate for Payer: PHCS Commercial |
$1,144.32
|
| Rate for Payer: United Healthcare All Payer |
$1,048.96
|
|
|
R-BAND 27CM
|
Facility
|
OP
|
$462.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem Medicaid |
$159.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Humana KY Medicaid |
$159.05
|
| Rate for Payer: Kentucky WC Medicaid |
$160.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
R-BAND 27CM
|
Facility
|
IP
|
$462.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
R-BAND 29CM
|
Facility
|
OP
|
$462.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem Medicaid |
$159.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Humana KY Medicaid |
$159.05
|
| Rate for Payer: Kentucky WC Medicaid |
$160.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
R-BAND 29CM
|
Facility
|
IP
|
$462.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
RBC DNA GNOTYP 10 BLD GROUPS
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 0084U
|
| Hospital Charge Code |
30002024
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$720.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$720.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$642.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,008.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$720.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$720.00
|
| Rate for Payer: Humana Medicare Advantage |
$720.00
|
| Rate for Payer: Kentucky WC Medicaid |
$727.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$864.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$734.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
RBC DNA GNOTYP 10 BLD GROUPS
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 0084U
|
| Hospital Charge Code |
30002024
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$642.40
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
RBC LEUKOCYTE REDUCE EA UN
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
38000008
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$565.25
|
| Rate for Payer: Humana Commercial |
$505.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$523.60
|
| Rate for Payer: Ohio Health Group HMO |
$446.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.45
|
| Rate for Payer: PHCS Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Payer |
$523.60
|
|
|
RBC LEUKOCYTE REDUCE EA UN
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
38000008
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: CareSource Just4Me Medicare |
$221.55
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$565.25
|
| Rate for Payer: Humana Commercial |
$505.75
|
| Rate for Payer: Humana KY Medicaid |
$204.62
|
| Rate for Payer: Humana Medicare Advantage |
$164.11
|
| Rate for Payer: Kentucky WC Medicaid |
$206.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.90
|
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem Medicaid |
$204.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$229.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$523.60
|
| Rate for Payer: Ohio Health Group HMO |
$446.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.45
|
| Rate for Payer: PHCS Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Payer |
$523.60
|
|
