|
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 |
$516.00 |
| 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 |
$1,376.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,186.80
|
| Rate for Payer: PHCS Commercial |
$1,651.20
|
| Rate for Payer: United Healthcare All Payer |
$1,513.60
|
|
|
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 |
$641.40 |
| Rate for Payer: Aetna Commercial |
$268.51
|
| Rate for Payer: Ambetter Exchange |
$134.44
|
| Rate for Payer: Anthem Medicaid |
$147.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$134.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$134.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$161.33
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$134.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.44
|
| 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 |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$374.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$134.44
|
|
|
RADIOPHARM THERAPY ADMIN
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
34000045
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$207.09 |
| 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 |
$207.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$833.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$289.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$279.57
|
| 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 |
$207.09
|
| 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 |
$248.51
|
| 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 |
$855.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$930.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$737.61
|
| 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 |
$320.70 |
| 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 |
$855.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$930.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$737.61
|
| Rate for Payer: PHCS Commercial |
$1,026.24
|
| Rate for Payer: United Healthcare All Payer |
$940.72
|
|
|
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 |
$280.69 |
| Rate for Payer: Aetna Commercial |
$268.51
|
| Rate for Payer: Ambetter Exchange |
$134.44
|
| Rate for Payer: Anthem Medicaid |
$147.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$134.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$134.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$161.33
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$134.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.44
|
| 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 |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$134.44
|
|
|
RADIOPHARM THERAPY ADMIN(T
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
340T0045
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$215.70 |
| 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 |
$575.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.11
|
| 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 |
$207.09 |
| 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 |
$207.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$560.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$289.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$279.57
|
| 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 |
$207.09
|
| 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 |
$248.51
|
| 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 |
$575.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.11
|
| Rate for Payer: PHCS Commercial |
$690.24
|
| Rate for Payer: United Healthcare All Payer |
$632.72
|
|
|
RAD RESECT ABD TUMOR 5 CM/>
|
Professional
|
Both
|
$3,175.00
|
|
|
Service Code
|
HCPCS 22905
|
| Hospital Charge Code |
76103038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.19 |
| Max. Negotiated Rate |
$2,374.09 |
| Rate for Payer: Aetna Commercial |
$2,092.78
|
| Rate for Payer: Ambetter Exchange |
$1,269.54
|
| Rate for Payer: Anthem Medicaid |
$980.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,269.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,269.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,523.45
|
| Rate for Payer: Cash Price |
$1,587.50
|
| Rate for Payer: Cash Price |
$1,587.50
|
| Rate for Payer: Cigna Commercial |
$2,374.09
|
| Rate for Payer: Healthspan PPO |
$1,492.89
|
| Rate for Payer: Humana Medicaid |
$980.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,709.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,269.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$999.79
|
| Rate for Payer: Molina Healthcare Passport |
$980.19
|
| Rate for Payer: Multiplan PHCS |
$1,905.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,650.40
|
| Rate for Payer: UHCCP Medicaid |
$1,111.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$989.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,269.54
|
|
|
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 |
$894.14 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| 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 |
$2,644.48
|
| 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 |
$3,173.38
|
| 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 |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
RAD RESECT HAND TUMOR 3 CM/>
|
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 |
$1,857.83 |
| Rate for Payer: Aetna Commercial |
$1,629.59
|
| Rate for Payer: Ambetter Exchange |
$1,002.51
|
| Rate for Payer: Anthem Medicaid |
$767.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,002.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,002.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,203.01
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,002.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.51
|
| 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 |
$1,303.26
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$775.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,002.51
|
|
|
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 |
$780.00 |
| 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 |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| 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 |
$1,857.83 |
| Rate for Payer: Aetna Commercial |
$1,629.59
|
| Rate for Payer: Ambetter Exchange |
$1,002.51
|
| Rate for Payer: Anthem Medicaid |
$767.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,002.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,002.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,203.01
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,002.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.51
|
| 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 |
$1,303.26
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$775.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,002.51
|
|
|
RA FACTOR QUAL (RHEUMATOID)
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
30001096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.92
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.83
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
RA FACTOR QUAL (RHEUMATOID)
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
30001096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem Medicaid |
$6.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.14
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| 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 |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.83
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
RALENZA (ZANIMIVIR) 5MG INHAL
|
Facility
|
OP
|
$14.70
|
|
|
Service Code
|
NDC 173068101
|
| Hospital Charge Code |
25001287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.41 |
| 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 |
$12.49
|
| 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 |
$11.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.14
|
| Rate for Payer: PHCS Commercial |
$14.11
|
| Rate for Payer: United Healthcare All Payer |
$12.94
|
|
|
RALENZA (ZANIMIVIR) 5MG INHAL
|
Facility
|
IP
|
$14.70
|
|
|
Service Code
|
NDC 173068101
|
| Hospital Charge Code |
25001287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.41 |
| 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 |
$12.49
|
| 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 |
$11.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.14
|
| 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 |
$8.99 |
| 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 |
$23.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.68
|
| 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 |
$8.99 |
| 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 |
$23.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.68
|
| Rate for Payer: PHCS Commercial |
$28.77
|
| Rate for Payer: United Healthcare All Payer |
$26.37
|
|
|
RANEXA (RANOLAZINE) 500MG
|
Facility
|
IP
|
$9.58
|
|
|
Service Code
|
NDC 50268072215
|
| Hospital Charge Code |
25001289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| 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 |
$7.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.61
|
| Rate for Payer: PHCS Commercial |
$9.20
|
| Rate for Payer: United Healthcare All Payer |
$8.43
|
|
|
RANEXA (RANOLAZINE) 500MG
|
Facility
|
OP
|
$9.58
|
|
|
Service Code
|
NDC 50268072215
|
| Hospital Charge Code |
25001289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$7.38
|
| 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 |
$7.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.61
|
| Rate for Payer: PHCS Commercial |
$9.20
|
| Rate for Payer: United Healthcare All Payer |
$8.43
|
|
|
RANGER GLOBAL DBC OTW 4*60*135
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DBC OTW 4*60*135
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW4*100*135
|
Facility
|
IP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$8,836.80 |
| Rate for Payer: Aetna Commercial |
$7,087.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,179.90
|
| Rate for Payer: Cash Price |
$4,602.50
|
| Rate for Payer: Cigna Commercial |
$7,640.15
|
| Rate for Payer: First Health Commercial |
$8,744.75
|
| Rate for Payer: Humana Commercial |
$7,824.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,548.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,793.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,100.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,008.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,351.45
|
| Rate for Payer: PHCS Commercial |
$8,836.80
|
| Rate for Payer: United Healthcare All Payer |
$8,100.40
|
|
|
RANGER GLOBAL DCB OTW4*100*135
|
Facility
|
OP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$8,836.80 |
| Rate for Payer: Aetna Commercial |
$7,087.85
|
| Rate for Payer: Anthem Medicaid |
$3,165.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,179.90
|
| Rate for Payer: Cash Price |
$4,602.50
|
| Rate for Payer: Cigna Commercial |
$7,640.15
|
| Rate for Payer: First Health Commercial |
$8,744.75
|
| Rate for Payer: Humana Commercial |
$7,824.25
|
| Rate for Payer: Humana KY Medicaid |
$3,165.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,197.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,548.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,793.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,229.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,100.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,008.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,351.45
|
| Rate for Payer: PHCS Commercial |
$8,836.80
|
| Rate for Payer: United Healthcare All Payer |
$8,100.40
|
|
|
RANGER GLOBAL DCB OTW4*120*150
|
Facility
|
OP
|
$8,091.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,427.53 |
| Max. Negotiated Rate |
$7,768.08 |
| Rate for Payer: Aetna Commercial |
$6,230.65
|
| Rate for Payer: Anthem Medicaid |
$2,782.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,311.56
|
| Rate for Payer: Cash Price |
$4,045.88
|
| Rate for Payer: Cigna Commercial |
$6,716.15
|
| Rate for Payer: First Health Commercial |
$7,687.16
|
| Rate for Payer: Humana Commercial |
$6,877.99
|
| Rate for Payer: Humana KY Medicaid |
$2,782.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,971.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,120.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,068.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,473.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,039.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.31
|
| Rate for Payer: PHCS Commercial |
$7,768.08
|
| Rate for Payer: United Healthcare All Payer |
$7,120.74
|
|
