|
RAPID STREP A POC
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$98.40 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$98.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$57.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
RAPID STREP A SCREEN PCR
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$102.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$59.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
RAPID STREP A SCREEN PCR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.51
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.30
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
RAPID STREP A SCREEN PCR
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| 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 |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.30
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
RAPIVAB 200MG/20ML VIAL
|
Facility
|
IP
|
$1,725.85
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
25002314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$517.75 |
| 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 |
$517.75
|
| 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 |
$1,380.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,501.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.84
|
| 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 |
$1.68 |
| 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 |
$1.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,346.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.27
|
| 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 |
$1.68
|
| 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 |
$2.02
|
| 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 |
$1,380.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,501.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.84
|
| Rate for Payer: PHCS Commercial |
$1,656.82
|
| Rate for Payer: United Healthcare All Payer |
$1,518.75
|
|
|
RA QUANT
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$65.40 |
| Rate for Payer: Aetna Commercial |
$8.77
|
| Rate for Payer: Ambetter Exchange |
$5.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.80
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$5.04
|
| Rate for Payer: Healthspan PPO |
$5.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$5.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.67
|
| Rate for Payer: Multiplan PHCS |
$65.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7.37
|
| Rate for Payer: UHCCP Medicaid |
$38.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.67
|
|
|
RA QUANT
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.14 |
| 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 |
$4.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.14
|
| Rate for Payer: PHCS Commercial |
$5.76
|
| Rate for Payer: United Healthcare All Payer |
$5.28
|
|
|
RA QUANT
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$5.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.67
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| 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 |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
RA QUANT
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.53
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
RA QUANT
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
30001100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.80 |
| 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 |
$4.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.14
|
| Rate for Payer: PHCS Commercial |
$5.76
|
| Rate for Payer: United Healthcare All Payer |
$5.28
|
|
|
RAZADYNE ER 8 MG CAPSULE
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 65862074430
|
| Hospital Charge Code |
25001292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| 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 |
$9.03
|
| Rate for Payer: Humana Commercial |
$8.07
|
| 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 |
$7.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.55
|
| 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 |
$2.85 |
| 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 |
$9.03
|
| Rate for Payer: Humana Commercial |
$8.07
|
| 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 |
$7.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.55
|
| Rate for Payer: PHCS Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Payer |
$8.36
|
|
|
RB82 RUBIDIUM
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
HCPCS A9555
|
| Hospital Charge Code |
34000062
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$381.00 |
| Max. Negotiated Rate |
$1,219.20 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem Medicaid |
$436.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Humana KY Medicaid |
$436.75
|
| Rate for Payer: Kentucky WC Medicaid |
$441.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$381.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$445.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$876.30
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
RB82 RUBIDIUM
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
HCPCS A9555
|
| Hospital Charge Code |
34000062
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$381.00 |
| Max. Negotiated Rate |
$1,219.20 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$381.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$876.30
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
R-BAND 27CM
|
Facility
|
OP
|
$466.25
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Anthem Medicaid |
$160.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.68
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cigna Commercial |
$386.99
|
| Rate for Payer: First Health Commercial |
$442.94
|
| Rate for Payer: Humana Commercial |
$396.31
|
| Rate for Payer: Humana KY Medicaid |
$160.34
|
| Rate for Payer: Kentucky WC Medicaid |
$161.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.30
|
| Rate for Payer: Ohio Health Group HMO |
$349.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.71
|
| Rate for Payer: PHCS Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Payer |
$410.30
|
|
|
R-BAND 27CM
|
Facility
|
IP
|
$466.25
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.68
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cigna Commercial |
$386.99
|
| Rate for Payer: First Health Commercial |
$442.94
|
| Rate for Payer: Humana Commercial |
$396.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.30
|
| Rate for Payer: Ohio Health Group HMO |
$349.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.71
|
| Rate for Payer: PHCS Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Payer |
$410.30
|
|
|
R-BAND 29CM
|
Facility
|
OP
|
$466.25
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Anthem Medicaid |
$160.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.68
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cigna Commercial |
$386.99
|
| Rate for Payer: First Health Commercial |
$442.94
|
| Rate for Payer: Humana Commercial |
$396.31
|
| Rate for Payer: Humana KY Medicaid |
$160.34
|
| Rate for Payer: Kentucky WC Medicaid |
$161.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.30
|
| Rate for Payer: Ohio Health Group HMO |
$349.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.71
|
| Rate for Payer: PHCS Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Payer |
$410.30
|
|
|
R-BAND 29CM
|
Facility
|
IP
|
$466.25
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.68
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cigna Commercial |
$386.99
|
| Rate for Payer: First Health Commercial |
$442.94
|
| Rate for Payer: Humana Commercial |
$396.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.30
|
| Rate for Payer: Ohio Health Group HMO |
$349.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.71
|
| Rate for Payer: PHCS Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Payer |
$410.30
|
|
|
RBC DNA GNOTYP 10 BLD GROUPS
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
HCPCS 0084U
|
| Hospital Charge Code |
30002024
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$568.56 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$634.48
|
| Rate for Payer: Anthem Medicaid |
$720.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$720.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$661.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,008.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$720.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cigna Commercial |
$683.92
|
| Rate for Payer: First Health Commercial |
$782.80
|
| Rate for Payer: Humana Commercial |
$700.40
|
| 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 |
$675.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$864.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$734.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$725.12
|
| Rate for Payer: Ohio Health Group HMO |
$618.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$716.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.56
|
| Rate for Payer: PHCS Commercial |
$791.04
|
| Rate for Payer: United Healthcare All Payer |
$725.12
|
|
|
RBC DNA GNOTYP 10 BLD GROUPS
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
HCPCS 0084U
|
| Hospital Charge Code |
30002024
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$247.20 |
| Max. Negotiated Rate |
$791.04 |
| Rate for Payer: Aetna Commercial |
$634.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$661.67
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cigna Commercial |
$683.92
|
| Rate for Payer: First Health Commercial |
$782.80
|
| Rate for Payer: Humana Commercial |
$700.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$675.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$725.12
|
| Rate for Payer: Ohio Health Group HMO |
$618.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$716.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.56
|
| Rate for Payer: PHCS Commercial |
$791.04
|
| Rate for Payer: United Healthcare All Payer |
$725.12
|
|
|
RBC LEUKOCYTE REDUCE EA UN
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
38000008
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$168.16 |
| Max. Negotiated Rate |
$608.64 |
| Rate for Payer: Aetna Commercial |
$488.18
|
| Rate for Payer: Anthem Medicaid |
$218.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$168.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$494.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$235.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$227.02
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$526.22
|
| Rate for Payer: First Health Commercial |
$602.30
|
| Rate for Payer: Humana Commercial |
$538.90
|
| Rate for Payer: Humana KY Medicaid |
$218.03
|
| Rate for Payer: Humana Medicare Advantage |
$168.16
|
| Rate for Payer: Kentucky WC Medicaid |
$220.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.92
|
| Rate for Payer: Ohio Health Group HMO |
$475.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$437.46
|
| Rate for Payer: PHCS Commercial |
$608.64
|
| Rate for Payer: United Healthcare All Payer |
$557.92
|
|
|
RBC LEUKOCYTE REDUCE EA UN
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
38000008
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$608.64 |
| Rate for Payer: Aetna Commercial |
$488.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$494.52
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$526.22
|
| Rate for Payer: First Health Commercial |
$602.30
|
| Rate for Payer: Humana Commercial |
$538.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.92
|
| Rate for Payer: Ohio Health Group HMO |
$475.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$437.46
|
| Rate for Payer: PHCS Commercial |
$608.64
|
| Rate for Payer: United Healthcare All Payer |
$557.92
|
|
|
RBC WASHED EA UNIT
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
38000010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$802.56 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.84
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
|
RBC WASHED EA UNIT
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
38000010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$287.50 |
| Max. Negotiated Rate |
$802.56 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem Medicaid |
$287.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$366.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$513.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$495.05
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Humana KY Medicaid |
$287.50
|
| Rate for Payer: Humana Medicare Advantage |
$366.70
|
| Rate for Payer: Kentucky WC Medicaid |
$290.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$440.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.84
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
