|
REM ENDOVAS VENA CAVA FILTER
|
Facility
|
OP
|
$3,690.00
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
76101532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,268.99 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Anthem Medicaid |
$1,268.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$3,062.70
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Humana Commercial |
$3,136.50
|
| Rate for Payer: Humana KY Medicaid |
$1,268.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,025.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,723.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,294.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,247.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,767.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,210.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,546.10
|
| Rate for Payer: PHCS Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Payer |
$3,247.20
|
|
|
REM ENDOVAS VENA CAVA FILTER
|
Professional
|
Both
|
$3,690.00
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
76101532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.08 |
| Max. Negotiated Rate |
$2,214.00 |
| Rate for Payer: Ambetter Exchange |
$323.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$299.08
|
| Rate for Payer: Anthem Medicaid |
$1,316.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$323.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$323.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$387.97
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$691.85
|
| Rate for Payer: Healthspan PPO |
$1,498.46
|
| Rate for Payer: Humana Medicaid |
$1,316.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$468.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$323.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,343.18
|
| Rate for Payer: Molina Healthcare Passport |
$1,316.84
|
| Rate for Payer: Multiplan PHCS |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.30
|
| Rate for Payer: UHCCP Medicaid |
$314.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,330.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$323.31
|
|
|
REMERON(MIRAZAPINE)45MG TAB
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 68084012101
|
| Hospital Charge Code |
25001301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
REMERON(MIRAZAPINE)45MG TAB
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
NDC 68084012101
|
| Hospital Charge Code |
25001301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
REMERON (MIRTAZAPINE) 15MG TAB
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 68084011901
|
| Hospital Charge Code |
25001300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
REMERON (MIRTAZAPINE) 15MG TAB
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 68084011901
|
| Hospital Charge Code |
25001300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
REMERON(MIRTAZAPINE)30MG TAB
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
NDC 68084012001
|
| Hospital Charge Code |
25001303
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
REMERON(MIRTAZAPINE)30MG TAB
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
NDC 68084012001
|
| Hospital Charge Code |
25001303
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
REM INTERROG DEV EVAL ICPMS
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 93297
|
| Hospital Charge Code |
48000090
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$42.57
|
| Rate for Payer: Ambetter Exchange |
$54.66
|
| Rate for Payer: Anthem Medicaid |
$21.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.59
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$43.00
|
| Rate for Payer: Healthspan PPO |
$40.02
|
| Rate for Payer: Humana Medicaid |
$21.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.49
|
| Rate for Payer: Molina Healthcare Passport |
$21.07
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.06
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.66
|
|
|
REM INTERROG DEV EVAL ICPMS
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 93297
|
| Hospital Charge Code |
48000090
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
REM INTERROG DEV EVAL ICPMS
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 93297
|
| Hospital Charge Code |
48000090
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
REM INTERROG DEV EVAL SCRMS
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
HCPCS 93298
|
| Hospital Charge Code |
48000091
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$81.30 |
| Max. Negotiated Rate |
$260.16 |
| Rate for Payer: Aetna Commercial |
$208.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$211.38
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$224.93
|
| Rate for Payer: First Health Commercial |
$257.45
|
| Rate for Payer: Humana Commercial |
$230.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$222.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$238.48
|
| Rate for Payer: Ohio Health Group HMO |
$203.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.99
|
| Rate for Payer: PHCS Commercial |
$260.16
|
| Rate for Payer: United Healthcare All Payer |
$238.48
|
|
|
REM INTERROG DEV EVAL SCRMS
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 93298
|
| Hospital Charge Code |
48000091
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$162.60 |
| Rate for Payer: Aetna Commercial |
$48.76
|
| Rate for Payer: Ambetter Exchange |
$90.65
|
| Rate for Payer: Anthem Medicaid |
$24.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.78
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$49.33
|
| Rate for Payer: Healthspan PPO |
$45.82
|
| Rate for Payer: Humana Medicaid |
$24.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.82
|
| Rate for Payer: Molina Healthcare Passport |
$24.33
|
| Rate for Payer: Multiplan PHCS |
$162.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$117.84
|
| Rate for Payer: UHCCP Medicaid |
$94.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.65
|
|
|
REM INTERROG DEV EVAL SCRMS
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS 93298
|
| Hospital Charge Code |
48000091
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$260.16 |
| Rate for Payer: Aetna Commercial |
$208.67
|
| Rate for Payer: Anthem Medicaid |
$93.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$211.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$224.93
|
| Rate for Payer: First Health Commercial |
$257.45
|
| Rate for Payer: Humana Commercial |
$230.35
|
| Rate for Payer: Humana KY Medicaid |
$93.20
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$94.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$222.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$238.48
|
| Rate for Payer: Ohio Health Group HMO |
$203.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.99
|
| Rate for Payer: PHCS Commercial |
$260.16
|
| Rate for Payer: United Healthcare All Payer |
$238.48
|
|
|
REM INTERROG EVL PM/IDS
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
HCPCS 93296
|
| Hospital Charge Code |
48000089
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$255.36 |
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.48
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cigna Commercial |
$220.78
|
| Rate for Payer: First Health Commercial |
$252.70
|
| Rate for Payer: Humana Commercial |
$226.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$196.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.08
|
| Rate for Payer: Ohio Health Group HMO |
$199.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.54
|
| Rate for Payer: PHCS Commercial |
$255.36
|
| Rate for Payer: United Healthcare All Payer |
$234.08
|
|
|
REM INTERROG EVL PM/IDS
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
HCPCS 93296
|
| Hospital Charge Code |
48000089
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$255.36 |
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Anthem Medicaid |
$91.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cigna Commercial |
$220.78
|
| Rate for Payer: First Health Commercial |
$252.70
|
| Rate for Payer: Humana Commercial |
$226.10
|
| Rate for Payer: Humana KY Medicaid |
$91.48
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$92.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$196.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.08
|
| Rate for Payer: Ohio Health Group HMO |
$199.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.54
|
| Rate for Payer: PHCS Commercial |
$255.36
|
| Rate for Payer: United Healthcare All Payer |
$234.08
|
|
|
REM INTERROG EVL PM/LDLS PM
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 93294
|
| Hospital Charge Code |
48000087
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$172.20 |
| Rate for Payer: Aetna Commercial |
$60.75
|
| Rate for Payer: Ambetter Exchange |
$27.52
|
| Rate for Payer: Anthem Medicaid |
$30.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$27.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$27.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.02
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$61.38
|
| Rate for Payer: Healthspan PPO |
$57.10
|
| Rate for Payer: Humana Medicaid |
$30.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$27.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.87
|
| Rate for Payer: Molina Healthcare Passport |
$30.26
|
| Rate for Payer: Multiplan PHCS |
$172.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.78
|
| Rate for Payer: UHCCP Medicaid |
$100.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.52
|
|
|
REM INTERROG EVL PM/LDLS PM
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS 93294
|
| Hospital Charge Code |
48000087
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
REM INTERROG EVL PM/LDLS PM
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 93294
|
| Hospital Charge Code |
48000087
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem Medicaid |
$98.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Humana KY Medicaid |
$98.70
|
| Rate for Payer: Kentucky WC Medicaid |
$99.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
REMINYL (GALANIT HYDRO)4MG TAB
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
NDC 65862045860
|
| Hospital Charge Code |
25001304
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.62
|
| Rate for Payer: Humana Commercial |
$4.13
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.28
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.35
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
REMINYL (GALANIT HYDRO)4MG TAB
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
NDC 65862045860
|
| Hospital Charge Code |
25001304
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.62
|
| Rate for Payer: Humana Commercial |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.28
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.35
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
REM MNTR WIRLSS PLMRT PRSRSNSR
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 93264
|
| Hospital Charge Code |
76102473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.77 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Ambetter Exchange |
$33.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.77
|
| Rate for Payer: Anthem Medicaid |
$40.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.88
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Humana Medicaid |
$40.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.80
|
| Rate for Payer: Molina Healthcare Passport |
$40.00
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.20
|
| Rate for Payer: UHCCP Medicaid |
$30.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.23
|
|
|
REM MNTR WIRLSS PLMRT PRSRSNSR
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 93264
|
| Hospital Charge Code |
76102473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
REM MNTR WIRLSS PLMRT PRSRSNSR
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 93264
|
| Hospital Charge Code |
761P2473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.77 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Ambetter Exchange |
$33.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.77
|
| Rate for Payer: Anthem Medicaid |
$40.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.88
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Humana Medicaid |
$40.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.80
|
| Rate for Payer: Molina Healthcare Passport |
$40.00
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.20
|
| Rate for Payer: UHCCP Medicaid |
$30.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.23
|
|
|
REM MNTR WIRLSS PLMRT PRSRSNSR
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 93264
|
| Hospital Charge Code |
76102473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
